Use of the Continuous Scale Physical Functional Performance Test in Stroke Survivors

Manns PJ, Tomczak CR, Jelani A, Cress ME, Haennel R. Use of the continuous scale physical functional performance test in stroke survivors.

Objective

To (1) determine the feasibility of the continuous scale physical functional performance 10-item test (CS-PFP10) for the measurement of physical function in stroke survivors, (2) characterize physical functional performance of stroke survivors and their matched controls, and (3) explore the associations among physical functional performance, ambulatory activity, and peak oxygen uptake (Vo₂peak).

Design

Case control.

Setting

University research setting.

Participants

Ten participants with stroke and 10 healthy controls matched for age, sex, and physical activity.

Interventions

Not applicable.

Main Outcome Measures

The CS-PFP10 test was used to measure functional ability. The test requires performance of 10 serial tasks that range from low to high difficulty. The step activity monitor was used to measure absolute ambulatory activity and was reported as the average number of steps a day over a 4-day period. Vo₂peak was determined using a metabolic cart and a recumbent cycle ergometer.

Results

Stroke survivors scored lower than healthy controls on all individual tasks, domains, and the total score on the CS-PFP10. Higher Vo₂peak was associated with higher total scores on the CS-PFP10 in both stroke survivors and controls. In stroke survivors, lower levels of impairment (as indicated by the Chedoke-McMaster stroke assessment) were associated with higher total CS-PFP10 scores.

Conclusions

The CS-PFP10 is a measure of physical performance that is feasible to use with ambulatory participants with stroke. Future investigations with people with stroke should explore the ability of the CS-PFP10 to provide meaningful information about change in CS-PFP10 subscales with interventions that target items on the subscales, such as balance or upper extremity strength.     

Predictors of Functional Performance in Community-Dwelling People with COPD

PURPOSE: To identify physiologic, well-being, and coping resource predictors of functional performance in community-dwelling people with COPD. DESIGN: A cross-sectional, correlational design was used with a convenience sample of 119 people who received care in a private pulmonary medicine practice. METHODS: Participants were recruited in person, completed the study instruments at home, and returned the instruments to the researcher by mail. Pulmonary function test results were obtained from medical records. Univariate, bivariate, and multiple regression analyses were performed. FINDINGS: Several bivariate correlations were robust, particularly among the well-being and coping resource variables, but none were large enough to indicate multicollinearity. Four proposed predictors (depression, severity of pulmonary disease, age, and gender) explained 46.3% of the variance in functional performance. CONCLUSIONS: Functional performance was influenced by both physiologic and negative well-being factors. Because of the potential influence of depression on adherence to medical regimen, attention to both physical and mental health is necessary for maintaining optimal health and functioning in these chronically ill people.     

引导式教育在成人偏瘫功能训练中的应用

目的:探讨偏瘫成人应用引导式教育(CE)训练的疗效。方法:脑损伤致偏瘫患者12例,均接受CE治疗。每日的功能活动训练与程序按CE的原理设计和实施。每天1次,共4周。治疗前后对患者的肌张力、运动功能及ADL分别按Ashworth评分法、运动评定量表(MAS)及Barther(BI)指数进行评分。结果:与治疗前比较,Ashworth、MAS及BI评分,12例患者均明显提高(P<0.05,0.01)。此外患者的独立运动及躯体、姿势控制意识和与人交流意识亦有所增强。结论:CE对于成人偏瘫具有明显疗效,值得在临床上推广应用。     

The Bay Area Functional Performance Evaluation: development and standardization

The Bay Area Functional Performance Evaluation (BaFPE) was developed in 1977-1978 to meet the need for a reliable and valid instrument for assessing the general functional performance of patients treated in psychiatric occupational therapy. It consists of two subtests, the Task-Oriented Assessment and the Social Interaction Scale. These subtests evaluate two aspects of general functional performance--task-oriented and social behavior--that are important in assessing clients with emotional, cognitive, or behavioral deficits. This article traces the instrument's standardization over a 10-year period of development and includes a discussion of its theoretical premises, its content, and the revisions to date. Research on the reliability and validity of the BaFPE is summarized.     

Effects of a Mobility Assistance Dog on the Performance of Functional Mobility Tests Among Ambulatory Individuals with Physical Impairments and Functional Disabilities

This study aims to verify whether individuals with physical impairments and ambulatory disabilities perform functional mobility tests faster using an assistance dog for mobility (AD_Mob). Thirty-four individuals with various physical impairments and functional disabilities performed at least one of the four functional mobility tests within their natural environment during an in-home assessment. Participants randomly performed the 10-meter walk test, the timed up-and-go (TUG) test, and the stair ascent and descent tests with and without an AD_Mob during an in-home assessment. The main outcome measure was the time needed to complete all tests with and without an AD_Mob. When using an AD_Mob, many participants (≥70.4%) were faster when performing the 10-meter walk test (15.7 ± 8.5s vs. 19.1 ± 11.2s), TUG test (23.6 ± 14.2s vs. 27.3 ± 16.5s), and stair ascent test (18.6 ± 13.5s vs. 22.4 ± 17.5s) compared to doing the tests without an AD_Mob. As for the stair descent test, the use of the AD_Mob had no significant effect on performance (20.7 ± 15.9s vs. 24.0 ± 17.1s). When using an AD_Mob, the majority of individuals with physical impairments and functional disabilities significantly improved their performance (i.e., reduced their time) during the 10-meter walk test, the TUG test and the stair ascent test.     

Isometric Muscle Function of Knee Extensors and the Relation With Functional Performance in Patients With Stroke

Gerrits KH, Beltman MJ, Koppe PA, Konijnenbelt H, Elich PD, de Haan A, Janssen TW. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke.

Objective

(1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors of the paretic limb and nonparetic limb in patients with stroke and compare these with able-bodied subjects. (2) To relate the contractile properties with different indices of functional performance.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Eighteen stroke patients and 10 able-bodied controls.

Interventions

Not applicable.

Main Outcome Measures

Maximal voluntary torque (MVT), maximal rate of torque development, time to maximal rate of torque development, half relaxation time (½RT), and fatigue index. Scores on the Functional Ambulation Category scale, Berg Balance Scale, and Rivermead Mobility Index as well as distance walked during the six-minute walk test were obtained.

Results

MVT of the paretic leg was lower than of the nonparetic leg (P<.05), and both limbs had lower MVT than controls (P<.05). Both the paretic and the nonparetic leg showed longer ½RT compared with controls (P<.05). The fatigue index was reduced in the paretic leg (P<.05) but not in the nonparetic leg compared with controls. MVT and fatigue index of the paretic leg were related to indices of functional performance (r=0.49-0.64; P<.05).

Conclusions

Apart from bilateral weakness, knee extensors in patients with stroke showed a lower rate of torque development and relaxation (both paretic and nonparetic leg) and lower fatigue resistance (paretic leg only) than controls, which in part may be a consequence of changes within the muscles. Strength and fatigue resistance relate to functional performance, indicating that these muscle properties should be addressed during rehabilitation. However, future research is needed to elucidate the efficacy of exercise programs.     

Is the Mini Mental Status Examination (MMSE) Associated with Inpatients’ Functional Performance?

ABSTRACT

Introduction: Occupational therapists in acute care settings often complete the Mini Mental Status Examination (MMSE) screening tool to assess inpatients’ cognitive state. The scores obtained are often informally linked to a patient's global function either on the ward and/or at the point of discharge. Therefore, what is the association between inpatients’ performance on the MMSE and their functional performance? Purpose: This study investigated the association between the MMSE and the functional performance of inpatients with suspected dementia. Method: A within-subjects quantitative research design was employed whereby a sample of 30 participants suspected of having dementia were recruited from three acute care hospital sites in metropolitan Melbourne, Australia. The MMSE was used to assess participants’ cognitive abilities while the Functional Independence Measure (FIM) provided a functional assessment score. Spearman's rho correlations and linear regression analyses were computed. Results: Eleven MMSE items were found to significantly associated with the FIM total score (Adjusted R² = 0.405, p < 0.05) and the FIM cognition subscale score (Adjusted R² = 0.683, p < 0.01). However, the MMSE items were not associated with the FIM motor subscale score (Adjusted R² = .315, p > 0.05). Conclusion: The MMSE scores derived for inpatients with a suspected dementia were significantly associated with the inpatients’ total FIM and cognition subscale scores, however, therapists need to be cautious when inferring any generalizations to inpatients’ motor task performance.     

Evaluation of the Performance of Information Theory-Based Methods and Cross-Correlation to Estimate the Functional Connectivity in Cortical Networks

Functional connectivity of in vitro neuronal networks was estimated by applying different statistical algorithms on data collected by Micro-Electrode Arrays (MEAs). First we tested these “connectivity methods” on neuronal network models at an increasing level of complexity and evaluated the performance in terms of ROC (Receiver Operating Characteristic) and PPC (Positive Precision Curve), a new defined complementary method specifically developed for functional links identification. Then, the algorithms better estimated the actual connectivity of the network models, were used to extract functional connectivity from cultured cortical networks coupled to MEAs. Among the proposed approaches, Transfer Entropy and Joint-Entropy showed the best results suggesting those methods as good candidates to extract functional links in actual neuronal networks from multi-site recordings.     

When is the Dyspnea Worth It? Understanding Functional Performance in People with Alpha-1 Antitrypsin Deficiency

Objective and Significance: To examine functional performance in people with emphysema because of alpha-1 antitrypsin (AAT) deficiency. A severe deficiency of AAT affects 1:3,500 to 1:1,670 Americans who can develop debilitating emphysema in the third to fifth decades of life.
Design: Exploratory.
Population: People with a severe deficiency of AAT.
Sample and Demographics: Thirty-three patients (27 men) with a mean age of 47 (SD=7) years.
Years: Data were collected 7993–7996.
Methods: Activities patients identified as important on the dyspnea subscale of the Chronic Respiratory Disease Questionnaire were categorized and interpreted within the context of an integrity framework (i.e., effectiveness—or connectedness-related).
Findings: Patients identified over 25 activities. Effectiveness activities, such as bathing, were mentioned most frequently (78%). Connectedness activities, such as praying with children, were mentioned less often (22%) but were ranked more important. Two patients reviewed and supported the content validity of the framework.
Conclusions: Results offer insight into the activities patients with genetic emphysema choose to perform and the factors that influence the decision that "the dyspnea is worth it."
Implications: Identifying the activities people with AAT deficiency choose to perform and understanding why these activities are meaningful can guide interventions to help patients maintain a sense of integrity.     

The Measurement of Balance and Walking Post-Stroke. Part 2: Functional Performance Tests

Abstract

The rehabilitation of balance and walking is a primary goal of stroke physiotherapy and our main interest is to assess the effectiveness of physiotherapy interventions. The literature was reviewed to seek functional performance tests (ratio and interval tests which require the subject to perform a balance or walking task) that would be suitable for such a purpose. CINAHL, Medline and Embase databases were searched for tests which measured balance and/or walking post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, suitability for use in clinical settings and with a wide range of stroke severity. Fourteen tests were identified. All had some information about their psychometric properties. They were generally reliable, valid, and sensitive to change, easy to use and suitable for community and hospital settings. An exception was timed balance tests, which showed poor reliability and validity. The main disadvantage is that any test is only suitable for a narrow range of ability, there is also insufficient information about the measurement error to be able to judge whether they could be used to assess the effects of specific interventions.     

Relationship Between Self-Reported Functional Limitations and Physical Performance Status Among Aged Home Care Clients

ABSTRACT

Objective: This study investigated relationship between self-reported functional limitations and measured physical performance among aged homecare clients. Design: Baseline measurement of a physical performance intervention. Setting: Health centers in six semi-urban and rural municipalities in Finland. Participants: One hundred and seventy-one aged (mean age 82 years.) home care clients. Measurements: Self-reported limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), functional balance by the Berg Balance Scale (BBS), physical performance by the Short Physical Performance Battery (SPPB), the 10-meter walking time test, and the hand grip strength test. Results: Significant interdependencies between the number of functional limitations and the measured performance status were found. In the hierarchical regression model, measures of performance status explained 40% of the variance of the functional limitations. Conclusions: A threshold of physical performance status on which people seem to report no or minimal limitation was found. Physical performance measures are independent predictors of functional limitations, and therefore, interventions should directly address factors associated with physical performance in order to enhance autonomy of aged persons.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.