Purpose
Objective functional tests like the five-repetition sit-to-stand test (5R-STS) can supplement an objective dimension to conventional patient-reported outcome measures. The reliability of ...unsupervised obtainment of 5R-STS performance is currently unknown.
Methods
We included patients with degenerative pathologies of the lumbar spine. Patients performed the 5R-STS during the initial clinical visit (supervised), as well as at home after instruction by a physiotherapist. At home, patients were first timed by a relative (unsupervised) and subsequently produced a video recording of themselves performing the 5R-STS for digital measurement (telesupervised). Two raters independently assessed the recordings.
Results
One hundred and twenty-one patients were recruited, of which 100 were eligible. Eighty-eight reported unsupervised results. Sixty-four returned recordings, of which 61 were ratable. Both unsupervised (
r
: 0.94, 95% CI 0.91–0.96,
p
< 0.001) and telesupervised (
r
: 0.90, 95% CI 0.83–0.94,
p
< 0.001) measurements demonstrated excellent correlation with clinical test times. Patients did not perform more slowly at home (
p
> 0.05). The interrater agreement for digital judgement of the telesupervised recording was excellent (ICC: 0.996, 95% CI 0.993–0.998,
p
< 0.001). We confirmed convergent validity with self-reported disability, back pain, and quality of life (all
p
< 0.05), but not with leg pain (
p
= 0.189).
Conclusions
Unsupervised at-home assessment using the 5R-STS is highly reliable. There does not appear to be a specific need for patients to return for a supervised 5R-STS follow-up. Rather, instructions can be provided, and the test performed and rated by a partner or family member at home. This is logistically and economically advantageous for patients, clinicians, and researchers.
Trial registry number
ClinicalTrials.gov Identifier: NCT03321357.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Purpose
We aimed to determine cut-offs between mild, moderate and severe myelopathy on the modified Japanese Orthopedic Association (mJOA) score.
Methods
Between December 2005 and January 2011, 757 ...patients with clinically diagnosed DCM were enrolled in the prospective AOSpine North America (
n
= 278) or International (
n
= 479) study at 26 sites. Functional status and quality of life were evaluated at baseline using a variety of outcome measures. Using the Nurick score as an anchor, receiver operating curve (ROC) analysis was conducted to determine cut-offs between mild, moderate and severe disease. The validity of the identified cut-offs was evaluated by examining whether patients in different severity groups differed in terms of impairment, disability, quality of life and number of signs and symptoms.
Results
A mJOA of 14 was determined to be the cut-off between mild and moderate myelopathy and a mJOA of 11 was the cut-off score between moderate and severe disease. Patients in the severe myelopathy group (
n
= 254) had significantly reduced quality of life and functional status and a greater number of signs and symptoms compared to patients classified as mild (
n
= 190) or moderate (
n
= 296).
Conclusions
Mild myelopathy can be defined as mJOA from 15 to 17, moderate as mJOA from 12 to 14 and severe as mJOA from 0 to 11. These categories should be adopted worldwide to standardize clinical assessment of DCM.
Despite recognizing the importance of events, researchers have rarely explored the influence of broader societal events on employee experiences and behaviors at work. We integrate perspectives on ...events and social identities to develop a cross-level theoretical model of the spillover effects of mega-threats, which we define as negative, large-scale, diversity-related episodes that receive significant media attention. With a focus on highly publicized instances of violence enacted against Black Americans by law enforcement as the mega-threat under study, we propose that the coupling of intrapsychic and group-level processes that occur as a result of a mega-threat leads minorities to experience identity fusion that involves the blurring of organizational and social identities through both affective and cognitive pathways. We further propose that identity fusion compels minorities to engage in task and relational positively deviant behaviors: progroup voice and relational bridging. We also propose that factors within the organizational context, including leader compassion, organizational climate for inclusion, and organizational demography, serve to empower minority employees, heightening the functional outcomes of mega-threats.
Individuals with schizophrenia are at greater risk for metabolic syndrome (MetS) which is associated with cognitive deficits in the general population. MetS might be potentially an important ...contributing factor to cognitive impairment in schizophrenia.
In the current systematic review and meta-analysis, the findings of 18 studies investigating the association between MetS (and its components) with cognitive impairment in schizophrenia are reviewed.
Co-morbidity of MetS (d = 0.28) and diabetes mellitus (d = 0.28) were both associated with more severe cognitive deficits in schizophrenia. There was also evidence for a significant relationship between cognitive impairment in schizophrenia and each of the components of MetS including hypertension, dyslipidemia, abdominal obesity and diabetes.
MetS is significantly associated with cognitive impairment in schizophrenia and can potentially contribute to functional decline observed in some patients with schizophrenia throughout the course of illness.
Objective
The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar ...disorder(BD) presenting moderate‐severe levels of functional impairment.
Methods
Two‐hundred and thirty‐nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run.
Results
The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM‐D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance.
Conclusions
Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.
ABSTRACT
Background
Outcome data regarding clinically relevant endpoints after starting dialysis for end-stage renal disease (ESRD) are sparse, and early events after starting dialysis are ...particularly underestimated. The aim of this study was to describe patient-focused outcomes in ESRD patients starting from first dialysis.
Methods
The data basis for this retrospective observational study were anonymized healthcare data from Germany's largest statutory health insurer. We identified ESRD patients who initiated dialysis in 2017. Deaths, hospitalizations and occurrence of functional impairment within 4 years after starting dialysis were recorded starting from first treatment. Hazard ratios in dialysis patients compared with an age- and sex-matched reference population without dialysis were generated, stratified by age.
Results
The dialysis cohort included 10 328 ESRD patients who started dialysis in 2017. First dialysis was performed in-hospital for 7324 patients (70.9%), and 865 of these died during the same hospitalization. One-year mortality for ESRD patients initiating dialysis was 33.8%. Functional impairment occurred in 27.1% of patients, while 82.8% of patients required hospitalization within 1 year. Hazard ratios of dialysis patients compared with the reference population for mortality, functional impairment and hospitalization at 1-year were 8.6, 4.3 and 6.2. Dialysis patients <50 years were disproportionately affected, with >40-fold increased risk of adverse events compared with their peers.
Conclusions
The emergence of morbidity and mortality after starting dialysis for ESRD is significant, especially in younger patients. Patients have a right to be informed about the prognosis associated with their condition.
Graphical Abstract
Graphical Abstract
Depression is common, impairing, and the leading cause of disease burden in youths. This study aimed to identify the effects of childhood/adolescent depression on a broad range of longer-term ...outcomes.
The analysis is based on the prospective, representative Great Smoky Mountains Study of 1,420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to 8 times in childhood (age 9-16 years; 6,674 observations; 1993-2000) for DSM-based depressive disorders, associated psychiatric comorbidities, and childhood adversities. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes and functional outcomes.
In all, 7.7% of participants met criteria for a depressive disorder in childhood/adolescence. Any childhood/adolescent depression was associated with higher levels of adult anxiety and illicit drug disorders and also with worse health, criminal, and social functioning; these associations persisted when childhood psychiatric comorbidities and adversities were accounted for. No sex-specific patterns were identified. However, timing of depression mattered: individuals with adolescent-onset depression had worse outcomes than those with child-onset. Average depressive symptoms throughout childhood and adolescence were associated with more adverse outcomes. Finally, specialty mental health service use was protective against adult diagnostic outcomes.
Early depression and especially persistent childhood/adolescent depressive symptoms have robust, lasting associations with adult functioning. Some of these effects may be attenuated by service use.
Abstract
Background
Early Supported Discharge (ESD) for Stroke is a complex intervention which enables people with new onset stroke to realise an accelerated discharge with rehabilitation in their ...home setting. ESD is supported with a robust evidence base, yet less is known about the specific experience of older adults. This paper aims to explore the experience and outcomes of patients over 65 years old in 2022 in a single stroke ESD site.
Methods
A password-encrypted database is held onsite, on which data for all ESD patients is inputted and updated during the time the patient is in the ESD service or shortly thereafter. The database was retrospectively reviewed to look at pertinent characteristics of the subgroup of ESD patients over 65 in 2022. Descriptive statistics were used to describe demographic details, functional outcomes, and predicted Length of Stay (LoS) saving in the acute hospital and LoS on the programme.
Results
Of 75 patients availing of ESD in the period, 47 were over 65 (62.6%). 63.8% of the over 65 cohort were female in contrast to 48% of the under 65 s. The Functional Independence Measure/Functional Assessment Measure (FIM/FAM) and Extended Activities of Daily Living (EADL) tools were used on admission and discharge. The FIM/FAM produced improvement score median of 6.08% and EADL, median score 12% among those over 65. The estimated LOS saving was the same across both groups (9.4 days). Average time on ESD programme was 29 days for this population, while those under 65 averaged at 46.6 days.
Conclusion
Older adults demonstrated functional gains in this ESD service, as measured by FIM/FAM and EADL measures, and they required less time in ESD than those under 65. Age did not influence acute LOS saving in this cohort. A larger review is indicated to determine trends over time and across ESD sites.
Abstract
Background
Approximately 6,000 people in Ireland had a stroke in 2020. Early Supported Discharge (ESD) is an international model of care for stroke patients. ESD improves patient outcomes ...while facilitating a faster discharge, through provision of stroke specific rehab at home. ESD can be expected to improve disability outcomes, quality of life and reduce length of hospital stay. A pilot ESD service was introduced in an acute hospital in 2021 and continues to provide stroke rehab for patients living within a 30-minute drive from an acute hospital.
Methods
A retrospective re-audit on routine data from 113 patients who partook in ESD from January 2021 to December 2022 from an acute hospital. Data was extracted from the ESD database and analysed.
Results
Implementation of an ESD service over 24 months between 2021 and 2022 achieved the following: (i) 50% increase in number of bed saving days between 2021 and 2022; (ii) In both 2021 and 2022, the percentage of stroke patients discharged with ESD was 25% of the total number of stroke patients; (iii) The average LOS of a stroke patient accepted to the ESD service continues to decrease. In 2021, average LOS for ESD patients was 11.7 days; 2022 it was 11 days; (iv) The number of stroke patients accepted by ESD service remains relatively unchanged. In 2021, 57 patients and in 2022, 56 patients were accepted to ESD and (v) Total FIM/FAM scores from admission to discharge with ESD continue to increase. In 2021, 8.1% increase in functional outcomes were recorded. In 2022, that increased to 9.5% demonstrating an improving independence levels when discharged with ESD.
Conclusion
The ESD service in an acute hospital continues to demonstrate Organisational and patient benefits. Participation in ESD rehabilitation impacted positively on functional performance as captured using the FIM-FAM. Ongoing implementation of ESD aims to continue to have a positive impact on length of patient stay, bed saving days and functional outcomes.
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