Utility of the Mayo-Portland Adaptability Inventory-4 for Self-Reported Outcomes in a Military Sample With Traumatic Brain Injury

Objective

To investigate the psychometric properties of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) obtained by self-report in a large sample of active duty military personnel with traumatic brain injury (TBI).

Design

Consecutive cohort who completed the MPAI-4 as a part of a larger battery of clinical outcome measures at the time of intake to an outpatient brain injury clinic.

Setting

Medical center.

Participants

Consecutively referred sample of active duty military personnel (N=404) who suffered predominantly mild (n=355), but also moderate (n=37) and severe (n=12), TBI.

Interventions

Not applicable.

Main Outcome Measure

MPAI-4

Results

Initial factor analysis suggested 2 salient dimensions. In subsequent analysis, the ratio of the first and second eigenvalues (6.84:1) and parallel analysis indicated sufficient unidimensionality in 26 retained items. Iterative Rasch analysis resulted in the rescaling of the measure and the removal of 5 additional items for poor fit. The items of the final 21-item Mayo-Portland Adaptability Inventory-military were locally independent, demonstrated monotonically increasing responses, adequately fit the item response model, and permitted the identification of nearly 5 statistically distinct levels of disability in the study population. Slight mistargeting of the population resulted in the global outcome, as measured by the Mayo-Portland Adaptability Inventory-military, tending to be less reflective of very mild levels of disability.

Conclusions

These data collected in a relatively large sample of active duty service members with TBI provide insight into the ability of patients to self-report functional impairment and the distinct effects of military deployment on outcome, providing important guidance for the meaningful measurement of outcome in this population.     

Psychometric Properties and Sex Differences on the Mayo-Portland Adaptability Inventory Participation Subscale (M2PI) in Veterans With Traumatic Brain Injury

ObjectiveTo evaluate the structural validity of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in a sample of veterans and to assess whether the tool functioned similarly for male and female veterans.DesignRasch analysis of M2PI records from the National Veterans Traumatic Brain Injury Health Registry database from 2012-2018.SettingNational VA Polytrauma System of Care outpatient settings.ParticipantsVeterans with a clinically confirmed history of traumatic brain injury (TBI) (N=6065; 94% male).InterventionsNot applicable.Main Outcome MeasuresM2PI, a 5-point Likert-type scale with 8 items. For this analysis, the 2 employment items were treated individually for a total of 9 items.ResultsThe employment items misfit the Rasch Measurement model (paid employment mean square [MnSq]=1.40; other employment MnSq=1.34) and were removed from subsequent iterations. The final model had eigenvalue 1.87 on the first contrast, suggesting unidimensionality of the remaining 7 items. Item order from least to most participation restriction was transportation, self-care, residence management, financial management, initiation, leisure, and social contact. Wright's person separation reliability for nonnormal distributions was 0.93, indicating appropriateness of M2PI for making individual-level treatment decisions. Mean person measure was −0.92±1.34 logits, suggesting that participants did not report restrictions on most items (item mean=0 logits). A total of 3.8% of the sample had the minimum score (no impairment on all items), and 0.2% had the maximum score. Four items had different item calibrations (≥0.25 logits) for female compared with male veterans, but the hierarchy of items was unchanged when the female sample was examined separately.ConclusionsThese findings suggest that, although employment is a poor indicator of participation restrictions among veterans with TBI, the M2PI is unidimensional. Because of subtle differences in scale function between male and female participants, M2PI should be part of a more thorough clinical interview about participation strengths and restrictions.     

肾移植出院受者自我管理教育模式的实施及评价

目的评价肾移植出院受者自我管理教育模式实施6个月后的效果。方法按照随机对照试验研究设计,将116名自愿参加本次调查的肾移植出院受者随机分为干预组和对照组。干预组接受自我管理教育,对照组接受常规健康教育,比较干预组和对照组在干预6个月之后各评价指标的变化。结果与对照组比较,干预组在治疗、躯体活动和社会心理方面的自我管理明显提高(P0.05);自我效能显著增强(P0.05);在饮食方面差异无统计学意义(P0.05)。干预组干预前后的血压、肌酐、尿素氮没有改变(P0.05)。结论肾移植出院受者自我管理教育6个月后可明显改善受者的自我管理行为、自我效能,提高受者的生活质量。     

Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post-inpatient rehabilitation brain injury programs

Eicher V, Murphy MP, Murphy TF, Malec JF. Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post–inpatient rehabilitation brain injury programs.ObjectiveTo compare progress in 4 types of post–inpatient rehabilitation brain injury programs.DesignQuasiexperimental observational cohort study.SettingCommunity and residential.ParticipantsIndividuals (N=604) with acquired brain injury.InterventionsFour program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments.Main Outcome MeasureMayo-Portland Adaptability Inventory (MPAI-4).ResultsProgram types differed in participant age (F=10.69, P<.001), sex (χ²=22.38, P<.001), time from first to second assessment (F=20.71, P<.001), initial MPAI-4 score (F=6.89, P<.001), and chronicity (F=13.43, P<.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores.ConclusionsResults are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs.     

潜在不适当用药对老年人不良健康结局影响的系统评价

目的 明确潜在不适当用药对老年人不良健康结局的影响,为预防不良健康结局提供依据.方法 检索PubMed、The Cochrane Library、Web of Science、EMBASE、中国生物医学文献数据库、中国知网和万方数据库,搜集建库至2019年2月关于潜在不适当用药对老年人不良健康结局影响的文献,采用RevMan 5.3软件进行分析.结果 共纳入33项队列研究,结果显示潜在不适当用药对药物不良反应、再次入院率有影响(RR=1.69,95%CI=1.28~2.23,P<0.001;RR=1.47,95%CI=1.30~ 1.66,P<0.001),但不会增加死亡率(RR=1.02,95%CI=0.98~ 1.07,P=0.310).结论 潜在不适当用药是老年人发生药物不良反应/药物不良事件和再次入院的危险因素,增加了社会经济负担,耗费了医疗资源.     

Upper Limb Assessment in Multiple Sclerosis: A Systematic Review of Outcome Measures and their Psychometric Properties

Objective

To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS.

Data Sources

PubMed and Web of Knowledge.

Study Selection

Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction.

Data Extraction

All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed.

Data Synthesis

A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT.

Conclusions

The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.     

Patient-Reported Upper Extremity Outcome Measures Used in Breast Cancer Survivors: A Systematic Review

Objectives

(1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research.

Data Sources

PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013.

Study Selection

Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English.

Data Extraction

A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2.

Data Synthesis

Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate.

Conclusions

Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations.     

Comparison of Treatment Outcomes in Nonspecific Low-Back Pain Patients With and Without Modic Changes Who Receive Chiropractic Treatment

Objective

The aim of this study was to determine if there was a difference in outcomes in patients with nonspecific low back pain, both with and without Modic changes (MCs), who received chiropractic care.

Lumbar Spinal Stenosis and Lower Extremity Motor Control: The Impact of Walking-Induced Strain on a Performance-Based Outcome Measure

Objective

The primary objective of this study was to quantify the lower extremity movements and capabilities of a population with lumbar spinal stenosis (LSS) compared with healthy age-matched controls under conditions of strain and no strain. The secondary objective was to identify challenging movement conditions for a population with LSS, on a lower limb aiming task with different levels of difficulty, compared with healthy age-matched controls under conditions of strain and no strain.

Methods

Using a nonrandomized, controlled, before-and-after design, LSS patients (n = 16) and healthy controls (n = 16) performed 2 blocks of great toe–pointing movements to a series of projected squares. Following block 1, participants completed a 12-minute progressive exercise treadmill test. Pointing movements were analyzed using 3D motion analysis. Behavioral and kinematic measures evaluated performance.

Results

Both groups' reaction times (RTs) lengthened as task difficulty increased. An interaction revealed that LSS patients were more adversely impacted by task difficulty, F (3,372) = 4.207; P = .006. The progressive exercise treadmill test facilitated RT for both groups, F (1,124) = 5.105; P = .026. Control participants showed less variability in time-to-peak velocity poststrain, a benefit not shared by LSS patients, t (31) = 2.149; P = .040.

Conclusion

A lower extremity movement task captured differences under strain between healthy and LSS populations. The lower extremity Fitts' Law task accurately measured differences between healthy and LSS participants. For the subjects in this study, strain was sufficient to prevent LSS patients from demonstrating improvement in the variability of the ballistic phase of movement execution, whereas LSS patients' movement performance remained unchanged. This study also showed that regardless of strain, as task difficulty increased, LSS patients were more adversely impacted in the planning and execution of their lower limb movements than healthy control participants. The lower extremity motor control task (Fitts' task) can be used as a performance-based outcome measure to measure differences between healthy and LSS populations.     

Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study

Background

Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient's previous hospitalisations.

Design and setting

Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia.

Objectives

The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes.

Results

During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p ≤ 0.001).

Conclusions

The results of this research suggest that nursing sensitive outcome rates may be over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources.     

The Anticancer Properties of Salvia Miltiorrhiza Bunge (Danshen): A Systematic Review

Salvia miltiorrhiza Bunge (Danshen in Chinese) is a classical Huoxue Huayu (a traditional Chinese medical term means promoting blood circulation and removing blood stasis) herb with 1000 years of clinical application. It mainly contains two groups of ingredients: the hydrophilic phenolic acids and the lipophilic tanshinones. Both groups have demonstrated multiple bioactivities, such as antioxidative stress, antiplatelet aggregation, anti‐inflammation, among others. Recent data have demonstrated that its lipophilic compounds, especially the tanshinones, show potent anticancer activities both in vitro and in vivo. The anticancer effects of the hydrophilic phenolic acids have also been reported. Furthermore, tanshinones provide structural skeletons for chemical modifications, allowing for a series of derivatives of interests. This review provides a systematic summary of the anticancer profile and the underlying mechanisms of the bioactive compounds isolated from Danshen with special emphasis on tanshinones, aiming to bring new insights for further research and development of this ancient herb.     

The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures

Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980–2007. Criteria for judging the “ideal” measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.     

How is the communication of bad news being performed in Neonatal Intensive Care Units and how to improve it: A Scoping Review

ObjectiveTo identify how the communication of bad news has been treated in the care of newborns admitted to Neonatal Intensive Care Units.MethodThis is a Scoping Review conducted according to the proposal of the Joanna Briggs Institute (JBI), using the databases LILACS, Scopus, PubMed, Web of Science, Embase and ScholarGoogle.ResultsDifferences were found in the view of parents and the health team regarding what is considered bad news and the way it is communicated - what would be ideal and what actually occurs -, in this context, highlighting the death imminent or potential risk of the newborn.ConclusionsDespite the knowledge about the particularities of the context, the professionals only make a situational diagnosis, requiring the use of tools or protocols that seek to facilitate understanding and reduce any trauma. In addition, points of change and investigation are brought into the daily practice of professionals, as well as key concepts for understanding the phenomenon.     

不同国家健康保障制度筹资机制变革因素的描述性系统评价

目的归纳和描述不同类型健康保障制度国家卫生筹资机制变革的推动或阻碍因素。方法由主题专家和检索人员讨论并试验后确定检索词，共检索19个电子数据库，2个卫生机构网站，2个灰色文献数据库和搜索引擎Google。纳入所有国家水平上实施卫生筹资机制变革的文章。用预先设计的数据提取表收集文章内容，根据设计的理论框架对提取的信息进行分析和描述。结果本系统评价共纳入59篇文献，经济的发展为各国卫生筹资变革提供了条件，卫生体制出现的问题可以直接导致变革的发生，而政治因素是大多数国家的推动因素，其中韩国是由于民主政治体制下上台政党推动了变革，泰国和德国是由于首相上台而实施的变革，意大利和法国则是由于卫生费用支出过大和卫生系统不公平而导致的变革。结论已实现全民健康保障的国家为发展中国家卫生筹资变革提供借鉴，在实行变革之前要充分了解和分析政治、经济和社会等影响因素，充分利用推动因素和避免阻碍因素。