Telephone-based Assessment Research Articles

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service.

There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with "red flag" breast symptoms. Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma. Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend. Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.

Telephone-based assessment of the fear of falling in older people and factors associated.

This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.

The Italian telephone-based Verbal Fluency Battery (t-VFB): standardization and preliminary clinical usability evidence.

BackgroundThis study aimed at standardizing and providing preliminary evidence on the clinical usability of the Italian telephone-based Verbal Fluency Battery (t-VFB), which includes phonemic (t-PVF), semantic (t-SVF) and alternate (t-AVF) verbal fluency tasks.MethodsThree-hundred and thirty-five Italian healthy participants (HPs; 140 males; age range = 18–96 years; education range = 4–23 years) and 27 individuals with neurodegenerative or cerebrovascular diseases were administered the t-VFB. Switch number and cluster size were computed via latent semantic analyses. HPs underwent the telephone-based Mental State Examination (MMSE) and Backward Digit Span (BDS). Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability and equivalence with the in-person Verbal Fluency tasks were assessed. Norms were derived via Equivalent Scores. Diagnostic accuracy against clinical populations was assessed.ResultsThe majority of t-VFB scores correlated among each other and with the BDS, but not with the MMSE. Switch number correlated with t-PVF, t-SVF, t-AVF scores, whilst cluster size with the t-SVF and t-AVF scores only. The t-VFB was underpinned by a mono-component structure and was internally consistent (Cronbach’s α = 0.91). Test-retest (ICC = 0.69–0.95) and inter-rater reliability (ICC = 0.98–1) were optimal. Each t-VFB test was statistically equivalent to its in-person version (equivalence bounds yielding a p < 0.05). Education predicted all t-VFB scores, whereas age t-SVF and t-AVF scores and sex only some t-SVF scores. Diagnostic accuracy against clinical samples was optimal (AUC = 0.81–0.86).DiscussionThe t-VFB is a valid, reliable and normed telephone-based assessment tool for language and executive functioning, equivalent to the in-person version; results show promising evidence of its diagnostic accuracy in neurological populations.

Decreasing delirium through music listening (DDM) in critically ill, mechanically ventilated older adults in the intensive care unit: a two-arm, parallel-group, randomized clinical trial

BackgroundDelirium is a highly prevalent and morbid syndrome in mechanically ventilated intensive care unit (ICU) patients. Music is a promising non-pharmacological intervention with beneficial effects on anxiety and stress, while its effects on delirium duration and severity are not well understood.Methods/designOur study is a two-arm, randomized parallel-group, clinical trial to evaluate the efficacy of music intervention compared to a silence-track attention control on delirium/coma duration in mechanically ventilated critically ill older adults.One hundred sixty mechanically ventilated adults 50 years of age or older will be randomized to one of two arms within 72 h of ICU admission: (1) 1-h music listening sessions twice daily through noise-canceling headphones, or (2) 1-h sessions of a silence track twice daily through noise-canceling headphones. Our primary aim is to compare delirium/coma-free days after randomization during the 7-day study intervention phase using the Confusion Assessment Method for the ICU (CAM ICU) and the Richmond Agitation Sedation Scale (RASS) for delirium and coma. Secondary outcomes include pain and anxiety evaluated twice daily during the intervention phase and throughout the duration of ICU stay using the Critical Care Pain Observation Tool (CPOT) and visual analog scale-anxiety (VAS-A). Enrolled participants will be followed after hospital discharge to further measure cognition as well as screening for depression and anxiety using the following telephone-based instruments: Indiana University Telephone-Based Assessment of Neuropsychological Status (IU TBANS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7).DiscussionThis randomized clinical trial will measure the efficacy of a music listening intervention for delirium and coma duration early in the intensive care unit among older adults.Trial registration.ClinicalTrials.gov. NCT04182334.

The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study.

BackgroundPeople with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD’s symptoms and carers’ burden.MethodsForty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD’s health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0.ResultsNo significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0.ConclusionPWD’s symptoms and carers’ burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer’s disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients’ carers.

Outcomes of a Telephone-Based Frailty and Functional Assessment

With the goal of increasing the clinical use of frailty, we piloted a quality improvement project to determine the feasibility and utility of a telephone-based frailty and functional assessment. We identified 122 established patients with serious medical illness from an academic geriatrics clinic. A geriatric fellow assessed the functional status and conducted the Mini Nutritional Assessment, telephone-MoCA, and Geriatric Depression Scale to generate a deficit-accumulation frailty index (FI) score which was automatically calculated through the electronic medical record. A note was then generated to inform the providers of the details of the assessment and to provide recommendations based on the findings. From November 2020 to March 2021, 104 out of 122 (85.2%) established patients (mean [SD]: 83.4 [7.1], 66% female, 81% White, and mean [SD] FI: 0.32 [0.17]) agreed and proceeded with the assessment. One month after the call, we found that the assessment was included in the clinical decision-making of 55 out of 100 patients seen by their primary care provider. The top 3 incorporated recommendations were chronic disease management based on frailty status (n=56), lifestyle change and counseling to prevent frailty progression (n=44), and management of cognition and mood (n=18). Management of physical status including referral to PT and OT were incorporated in 15 encounters. Our results suggest that a telephone-based frailty and functional assessment is feasible and has value-added contributions in improving the care of older adults through providing a holistic view of their health status.

Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19.

BackgroundThere is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. Objective: We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients.MethodsApproximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function.ResultsMost Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%–32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores.ConclusionsAt approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.

Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic

BackgroundAssessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS).ResultsThe Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference.ConclusionThe Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.

Telephone-based assessment of walking confidence in older people.

To validate the telephone-based application of the modified Gait Efficacy Scale (mGES) for the assessment of walking confidence in older people. Participants answered the mGES-Brazil on two randomized occasions, face-to-face and by telephone. The mean difference (MD) between the interviews was reported. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions for total mGES-Brazil scores and for the individual items. A total of 78 individuals were included. There was no significant difference in the MD obtained between applications of the mGES (1 point, 95% confidence interval -6 to 7). A very high level of agreement was found between the mGES total scores during face-to-face and telephone applications (ICC = 0.98; 95% CI 0.97-0.99). All items, except one (item 3), had a very high agreement between the two applications. The mGES showed to be reliable to be applied for telephone assessments of walking confidence in older people.

The impact of the cessation of primary dental care services on oral cancer diagnosis at a single institution in the UK's epicentre during the COVID-19 pandemic.

AimsCOVID‐19 put an unprecedented strain on healthcare services that was complicated by the widespread cessation of all face‐to‐face primary care dental activity from 23 March 2020 for 7 weeks. This led to a focus on telephone triage and remote prescribing that potentially impeded urgent referrals for suspected oral cancer. Guy's and St Thomas' NHS Foundation Trust (GSTFT) screens and diagnoses potential head and neck cancer patients via a 2‐week wait (2 WW) clinic and provides access to patients with urgent oral health needs through an Acute Dental Care (ADC) service. The current service evaluation aims to assess and report on the impact of COVID‐19 and the cessation of primary care dentistry on oral cancer diagnosis at GSTFT during a period of time where patients had extremely limited access to healthcare.Materials and MethodsData regarding oral cancer diagnoses were collected retrospectively from secure logbooks and clinical records from the point at which routine dental practice was nationally halted (23 March 2020) to the date at which services were permitted to resume (08 June 2020). Individual patient pathways prior to diagnosis and through to treatment were recorded.ResultsSixteen new diagnoses of oral cancer were made during the described timeframe. Findings suggest that the paralysis of routine dental services resulted in delayed referral of suspicious lesions and highlights the limitations of a predominately telephone‐based assessment service in primary care.ConclusionThe importance of the role of the primary care practitioner in the early identification of oral cancer has been emphasised.

Clinical significance of smell and taste dysfunction and other related factors in COVID-19.

PurposeThe objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients.MethodsPatients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology–Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS).ResultsA total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22–20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. ‘Ground-glass appearance’ on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman’s rho-0.404, p = 0.022) but not correlated with nasal breathing scores.ConclusionSTD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.Electronic supplementary materialThe online version of this article (10.1007/s00405-020-06503-9) contains supplementary material, which is available to authorized users.

The Relationship Between Activity Participation and Cognitive Functioning

Researchers are growing increasingly interested in how the diversity of daily activities are related to well-being. The current study examined how both frequency and diversity in daily activities are associated with cognitive functioning. Participants from the third wave (2013-2016) of the Midlife Development in the U.S (MIDUS) survey (N=1281) completed both a telephone-based cognitive assessment and a mailed survey asking about participation in three different types of activities: cognitive (e.g., doing word games, attending educational lectures or courses), physical (e.g,. exercise, home chores), and social (volunteer work, attending sports or social groups). Frequency of activity participation was assessed with items asking how often they engaged in these activities, and diversity of activity participation was calculated by summing the number of activities they reported doing in each category. All analyses included sociodemographic variables, health status, and openness to experience as covariates. Findings from multiple regression indicated that greater frequency in all activities (cognitive, physical, and social) was related to higher levels of cognitive functioning. Greater diversity of social activity was also related to higher cognitive functioning. Education mediated the association between diversity in cognitive activities and cognitive functioning, suggesting that the link between higher levels of cognitive functioning and education may be partly attributed to people with higher levels of education engaging in greater diversity of cognitive activity.

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

BackgroundThe outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany.MethodsThis analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown.ResultsThe vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased.ConclusionsThe study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

Validation of the telephone-based assessment of locomotion ability after stroke.

The aim of the study was to validate the telephone-based application of the ABILOCO questionnaire for the assessment of locomotion ability after stroke. Individuals after stroke answered the ABILOCO-Brazil questionnaire on two randomized occasions, face-to-face and by telephone, 5-7 days apart. The mean difference between the interviews was reported. Intraclass correlation coefficient (ICC) was calculated to investigate the agreement between the total scores, and weighted-Kappa statistics to investigate the agreement between the individual items. A total of 92 individuals were included. There was no significant difference in the mean scores between face-to-face and telephone-based applications of the ABILOCO [mean difference 0.17 logits; 95% confidence interval (CI), -0.88 to 0.54]. A high level of agreement was found between the ABILOCO total scores obtained between both applications (ICC = 0.90; 95% CI, 0.84-0.93), and most of the individual items had, on average, moderate agreement. The ABILOCO showed to be a reliable questionnaire for telephone assessment of locomotion ability after stroke.

Abstract 225: The Adverse Mental Health Impact of Emergency Medical Services Related Public Health Messaging for Cardiac Arrest Patients During the Covid-19 Pandemic

Introduction: In light of the COVID-19 pandemic, various emergency medical services (EMS) and health agencies in New York City (NYC), and other hard-hit cities, issued new guidelines terminating resuscitation efforts in cases of out of hospital cardiac arrests (CA). This guidance was issued to protect the health and safety of EMS providers, to conserve hospital resources, and to ensure optimal use of equipment to save the greatest number of lives. However, the psychological impact of this public health messaging on existing CA survivors has not yet been studied. Methods: Between 5/15 - 5/18 of 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from an ongoing, prospective study, were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; e.g., “I am stressed around other people because I worry I’ll catch the coronavirus;” range 1-42). Survivors’ self-reported fear and uncertainty in receiving immediate life-saving care in the event of a CA due to recent public health messaging was assessed on a 5-point Likert-scale (Not at all—extremely). Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% non-Hispanic White, 20% Black, and 31% Latinx). The majority, 63 of 75 (84%), had no COVID-19 symptoms or had not been tested. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37). Participants who were “very to extremely” afraid that emergency care would not come if they had another CA made up 45% (34 of 75; 95% C.I: 34-57) and scored 1 SD higher (mean±SD 34±6 vs 23±9, p&lt;0.001) on COVID-19 anxiety scores than those with little fear about the availability of emergency care. The association was significant after adjusting for age, race, sex, and COVID-19 testing status (Odds Ratio = 1.17; 95% CI: [1.079, 1.274]; p&lt;0.001). Conclusion: A better understanding of the potential psychological impact of disaster-related public health messaging is needed to prevent campaigns from causing additional distress and contributing to poor mental health and quality of life.

Abstract 223: Association Between Covid-19 Pandemic Related Anxiety and Advanced Care Planning Desire in Cardiac Arrest Survivors

Introduction: Patients with cardiovascular disease conditions are at high risk for direct and indirect impacts of COVID-19 on morbidity and mortality. In light of this, we aimed to assess the extent to which COVID-19-related anxiety in patients with a history of cardiac arrest (CA) correlates with the desire to change or discuss advanced directives. Methods: Between May 15-28, 2020, a month after the New York City (NYC) COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and other survivorship dimensions. COVID-19-related anxiety was measured by the Generalized Anxiety Disorder-3 scale, which asks how often respondents felt (1) anxious, (2) unable to stop worrying, and (3) excessively worried over two weeks, and was keyed to the COVID-19 pandemic. Desire to discuss or to change financial and/or health-related advanced directives were reported on a yes-or-no basis. Results: 100 approached, 69 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). A majority, 58 of 69 (84%), had no COVID-19 symptoms and/or were not tested. Only 12 of the 69 respondents (17%) showed interest in discussing or changing advanced directives. There were no significant differences in the age, sex, race, or COVID-19 symptoms status between those who showed desire versus those who did not. Desire to change advance directives was significantly associated with increased COVID-19-related anxiety (OR 1.5, CI 95% [1.2-1.9] p&lt;0.002). Conclusions: In CA survivors, a desire to change financial or healthcare-related advanced directives during the COVID-19 outbreak was associated with increased pandemic-related anxiety. The causality and directionality of this relationship require further, qualitative study.

Abstract 219: Characterizing Covid-19 Pandemic Related Anxiety and Its Impact on Cardioprotective Health Behaviors Among Racially and Ethnically Diverse Cardiac Arrest Survivors

Introduction: Cardiac arrest (CA) patients’ fear of contracting Coronavirus disease 2019 (COVID-19) may limit their ability or willingness to perform cardio-protective health behaviors. We assessed the association of COVID-19 anxiety with physical activity (PA), sleep, and the likelihood of seeking medical care. Methods: Between May 15-28, 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; range 1-42). PA in 7 days both pre- and during COVID-19 was categorized into International Physical Activity Questionnaire-based low, moderate, or high activity levels. Self-reported poor sleep quality and hours of sleep per night in the previous month were assessed via the Pittsburgh Sleep Quality Index. Self-reported likelihood of delay in seeking care for non-COVID related conditions was assessed. Results: Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). The majority (84%) were COVID-19 tests and/or symptoms negative. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37)- indicating substantial fear. Black and Latinx participants reported greater COVID-19 anxiety than White (33±6 vs 32±8 vs 23±10 respectively, p=0.03). Compared to pre-COVID, CA survivors had reduced their days per week engagement in any PA by an average of 2±3.6 days. COVID-19 anxiety was highest in those who were previously high PA and now were low PA (high-high:25±9, low-low:28±9, and high-low:32±4, ANOVA p=0.06). For every 1 SD increase in COVID-19 anxiety, participants reported 45 min less sleep per night (B= -0.05, p =.06) and poorer sleep quality (OR = 1.07, 95% CI [1.0, 1.1], p=0.017). Participants (48%) who said they were “moderately” to “extremely” likely to delay seeking care for non-COVID related conditions had greater levels of COVID-19 anxiety (32±9 vs 26±10, p=0.02) compared to other responses. Conclusions: COVID-19 anxiety is more frequent in Black and Latinx participants and is associated with poorer health behaviors.

Validation of the Telephone-Based Application of the ABILHAND for Assessment of Manual Ability After Stroke.

Telephone-based assessment may be a valuable and cost-effective approach to improve monitoring and follow-up assessments in patients and research participants. Telephone-based assessment may be of particular value during times when it is important to reduce in-person contract, such as during the Covid-19 pandemic. The purpose of this study was to investigate concurrent validity of the telephone-based administration of the ABILHAND for the assessment of manual ability in individuals with stroke. Using a cross-sectional study design, participants with stroke were invited to answer the ABILHAND questionnaire on 2 randomized occasions, face to face and by telephone, 5 to 7 days apart. The mean difference (MD) between the interviews was calculated (95% confidence interval [95% CI]) to investigate the concurrent validity. Intraclass correlation (ICC) and weighted κ coefficients were used to investigate the agreement between face-to-face and telephone-based administration. One hundred two participants (50 men; mean age = 65 years, SD = 13 years) were included. No significant differences were observed between the mean scores obtained with face-to-face and telephone-based administration of the ABILHAND (MD = -0.06; 95% CI, -0.72 to 0.60). Very high agreement was found between face-to-face and telephone-based administration (ICC = 0.90; 95% CI, 0.85 to 0.93) on the ABILHAND total scores. Most of the individual items had moderate or substantial κ agreement. Telephone-based administration of the ABILHAND is valid for the assessment of manual ability after stroke. Clinicians and researchers may use the ABILHAND for monitoring manual ability in persons with stroke and/or screening potential research participants.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A318).

Accuracy of Telephone-Based Cognitive Screening Tests: Systematic Review and Meta-Analysis.

Telephone-based cognitive assessments may be preferable to in-person testing in terms of test burden, economic and opportunity cost. We sought to determine the accuracy of telephone-based screening for the identification of dementia or Mild Cognitive Impairment (MCI). Five multidisciplinary databases were searched. Two researchers independently screened articles and extracted data. Eligible studies compared any multi-domain telephone-based assessment of cognition to the face-to-face diagnostic evaluation. Where data allowed, we pooled test accuracy metrics using the bivariate approach. From 11,732 titles, 34 papers were included, describing 15 different tests. There was variation in test scoring and quality of included studies. Pooled analyses of accuracy for dementia: Telephone Interview for Cognitive Status (TICS) (<31/41) sensitivity: 0.92, specificity: 0.66 (6 studies); TICSmodified (<28/50) sensitivity: 0.91, specificity: 0.91 (3 studies). For MCI: TICS-modified (<33/50) sensitivity: 0.82, specificity: 0.87 (3 studies); Telephone-Montreal Cognitive Assessment (<18/22) sensitivity: 0.98, specificity: 0.69 (2 studies). There is limited diagnostic accuracy evidence for the many telephonic cognitive screens that exist. The TICS and TICS-m have the greatest supporting evidence; their test accuracy profiles make them suitable as initial cognitive screens where face to face assessment is not possible.

Mid-term results after proximal humeral fractures following angular stable plate fixation in elderly patients\u2014which scores can be evaluated by a telephone-based assessment?

BackgroundThe aim was to evaluate postsurgical outcome in elderly patients (> 70 years) after open reduction and internal fixation (ORIF) of proximal humeral fractures and compare the test-retest agreement of scores which are frequently used to assess the outcome of upper extremity disorders.MethodsNinety patients (78.1 ± 5.2 years) with a minimum follow-up of 2 years (3.7 ± 0.9 years) following angular stable plate fixation of a proximal humeral fracture (2-part: 34, 3-part: 41, 4-part: 12) were enrolled. Two telephone-based interviews assessed Disabilities of the Arm, Shoulder and Hand Score (DASH), Oxford Shoulder Score (OSS), and Constant Score adjusted for interview assessment (CS) by two independent interviewers. Correlations, Bland-Altman analyses, Cross tabulation, and weighted Kappa measure of agreement (k) were calculated to assess differences and the test-retest agreement between the categories of each score.ResultsIn the first and second interview, we could state fair outcomes: CS 91 (range 40–100) and 65.5 (23–86), DASH 12.5 (0–64.2) and 18.3 (0–66.7), and OSS 58 (33–60) and 55 (25–60) points.The test-retest correlations were r = 0.67, r = 0.77, and r = 0.71 for CS, DASH, and OSS. Bland-Altman analyses showed absolute mean individual score differences of − 22.3, 4.9, and − 3.0 for CS, DASH, and OSS. Limits of agreement represented possible differences of 21.6%, 15.5%, and 9.0% of CS, DASH, and OSS. The category agreements were medium to high: CS 55.9% (k = 0.08), DASH 87.2% (k = 0.62), and OSS 99.3% (k = 0.74).ConclusionPatients showed good subjective outcomes. The test-retest agreement of the interview-adjusted CS was low, but telephone-based assessment of OSS and DASH present as an alternative to collect outcomes in elderly patients.Trial registration(250/2011BO2).