A Sentimentalist Theory of Mind, by Michael Slote.

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Apical Resection Mouse Model to Study Early Mammalian Heart Regeneration

A step-by-step video protocol of apical resection is demonstrated in this study. Apical resection is a recently highlighted surgical approach in mammalian heart regeneration research. This study may promote the application of apical resection as a standard methodology in research into the mechanism underlying heart regeneration.

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A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

To study combined solid organ and vascularized composite allotransplantation, we describe a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique.

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Longitudinal Associations of Friend-Based Social Support and PTSD Symptomatology during a Cannabis Cessation Attempt

Publication date: Available online 23 January 2016
Source:Journal of Anxiety Disorders
Author(s): Sarah P. Carter, Jennifer DiMauro, Keith D. Renshaw, Timothy W. Curby, Kimberly A. Babson, Marcel O. Bonn-Miller
Research supports bidirectional associations between social support and posttraumatic stress disorder (PTSD), whereby social support may buffer against PTSD, and individuals with PTSD may experience decreasing support over time. Research examining contexts that may affect these relations is needed. This study examined the longitudinal associations between PTSD and social support from friends over a 6-month period in 116 veterans with cannabis dependence who had recently initiated an attempt to quit cannabis use. A cross-lagged autoregressive model revealed a significant, negative relation between earlier PTSD symptoms and later support. An exploratory multigroup analysis comparing those with and without a relapse in the first month after their quit attempt revealed that the significant negative association between PTSD and future support was present only in those who relapsed. Although this analysis was limited by a small sample size, results suggest that substance use may be an influential contextual variable that impacts the longitudinal associations between PTSD and support.

Graphical abstract

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Implication of Immunokine Profiling for Cancer Staging

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): Kawngwoo Park, Madhusmita Dhupal, Cheol-Su Kim, Yoon-Sun Park, Soo-Ki Kim
Tumor may arise from the dysregulation of immune system, which plays pivotal roles in counteracting tumor colonization, late-stage tumors, and metastases. In the midst of the establishment of cancer in vivo, immune cells are activated to release a multitude of immunokines, such as cytokines, and chemokines. Thus, since cytokine levels in tumor bearing host would be differential among local (intratumoral lesion, peritumoral normal tissue), and systemic sample site (serum), these differences might be significantly correlated to prognosis and treatment outcome for cancer patients. Previously, despite small number of patients, we demonstrated the feasibility of this proposition via only cytokine profiling. Based on this, herein we propose that immunokine profiling would be used as a surrogate, predictive tool for cancer staging, and progression.



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Systemic activation of the immune system in HIV infection: the role of the immune complexes (hypothesis)

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): Larisa B. Korolevskaya, Konstantin V. Shmagel, Nadezhda G. Shmagel, Evgeniya V. Saidakova
Currently, immune activation is proven to be the basis for the HIV infection pathogenesis and a strong predictor of the disease progression. Among the causes of systemic immune activation the virus and its products, related infectious agents, pro-inflammatory cytokines, and regulatory CD4+ T cells' decrease are considered. Recently microbial translocation (bacterial products yield into the bloodstream as a result of the gastrointestinal tract mucosal barrier integrity damage) became the most popular hypothesis. Previously, we have found an association between immune complexes present in the bloodstream of HIV infected patients and the T cell activation. On this basis, we propose a significantly modified hypothesis of immune activation in HIV infection. It is based on the immune complexes' participation in the immunocompetent cells' activation. Immune complexes are continuously formed in the chronic phase of the infection. Together with TLR-ligands (viral antigens, bacterial products coming from the damaged gut) present in the bloodstream they interact with macrophages. As a result macrophages are transformed into the type II activated forms. These macrophages block IL-12 production and start synthesizing IL-10. High level of this cytokine slows down the development of the full-scale Th1-response. The anti-viral reactions are shifted towards the serogenesis. Newly synthesized antibodies' binding to viral antigens leads to continuous formation of the immune complexes capable of interacting with antigen-presenting cells.



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Hypothesis: A single dose of an anxiolitic may prevent unnecessary visits to the emergency room during blood pressure elevations

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): Howard Tandeter




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Insulin resistance is a two-sided mechanism acting under opposite catabolic and anabolic conditions

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): P. Schwartsburd
The survival of multi-cellular organisms depends on the organism ability to maintain glucose homeostasis for time of low/high nutrient availability or high energy needs, and the ability to fight infections or stress. These effects are realized through the insulin controlled transport of blood glucose into the insulin-responsive cells such as muscle, fat and liver cells. Reduction in the ability of these cells to take glucose from the blood in response to normal circulating levels of insulin is known as insulin resistance (IR). Chronic IR is a key pathological feature of obesity, type 2 diabetes, sepsis and cancer cachexia, however temporal IR are widely met in fasting/ hibernation, pregnancy, anti-bacterial immunity, exercise and stress. Paradoxically, a certain part of the IR-cases is associated with catabolic metabolism, whereas the other is related to anabolic pathways. How can this paradoxical IR-response be explained? What is the metabolic basis of this IR variability and its physiological and pathological impacts? An answer to these questions might be achieved through the hypothesis in which IR is considered as a two-sided mechanism acting under opposite metabolic conditions (catabolism and anabolism) but with the common aim to sustain glucose homeostasis in a wide metabolic range. To test this hypothesis, I examined the main metabolic distinctions between the varied IR-cases and their dependence on the blood glucose concentration, level of the IR-threshold, and catabolic/anabolic activation. On the basis of the established interrelations, a simple model of IR-distribution has been developed. The model revealed the «U-type distribution» form with separation into two main IR-groups, each determined in the catabolic or anabolic conditions with one exception – type 2 diabetes and its paradoxical catabolic activation in anabolic conditions. The dual opposing (or complementary) role for the IR opens a new possibility for better understanding the cause and consequences of transition from adaptive IR-responses to its pathological forms.



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The low-frequency (delta and theta) oscillations model of hallucinations integrating neuronal mechanism of object representation, emotions, plasticity, memory and noise signal

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): Grzegorz R. Juszczak




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Great expectations: Nutritional medicine as a mainstream in clinical psychiatry and weighing opportunities against risks

Publication date: Available online 23 January 2016
Source:Medical Hypotheses
Author(s): F.D. Zepf, R.M. Stewart, S. Hood, G.J. Guillemin




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ICF - Measure of Participation and Activities Screener

Acronym:

IMPACT-S

Purpose:

The ICF-Measure of Participation and Activities Screener (IMPACT-S) is a self-report measurement instrument to assess experienced limitations in activities and participation. The questions concern aspects of daily life in which a person could possibly experience limitations as a consequence of their health or disability. The score is used to indicate low or high levels of participation.

The 32 questions are distributed across 9-scales, reflecting the 9 activity and participation domains of the International Classification of Functioning, Disability and Health (ICF). The IMPACT-S is the screener portion of the ICF Measure of Participation & Activities (IMPACT) questionnaire (Post et al., 2008). The measure was designed to describe functioning and disability independent of health conditions.

Description:

IMPACT-S is a 32-item questionnaire. Each item contains a question about experiences in one's life, examples how the limitation might be experienced, and a 4-point limitation rating scale (No, no limitations whatsoever; Yes, some limitations; Yes, considerable limitations; Yes, I cannot do that at all).

In addition to a total score, 9 scale scores (one per ICF domain), and 2 subtotal scores for activities and participation can be computed. All summary scores are converted to a score on a 0 to 100 scale, with higher scores indicating higher levels of participation and lower scores indicating greater limitations to participation.

Area of Assessment: Life Participation

Body Part: Not Applicable

ICF Domain: Activity, Participation

Domain: ADL, Cognition, Emotion, General Health, Motor, Sensory

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less, 06 to 30 Minutes

Time to Administer:

No published data on administration time (Magasi & Post, 2010).

Number of Items: 32

Equipment Required:

None

Training Required:

No Training

Type of training required: No Training

Cost: Free

Actual Cost:

Free

Age Range: Adolescent: 13-17 years, Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Acquired Brain Injury, Arthritis, Cardiac Conditions, Cerebral Palsy, Chronic Obstructive Pulmonary Disease, Concussion, Fibromyalgia, Geriatrics, Hip Fracture, Knee Dysfunction, Lower Limb Amputation, Movement Disorders, Multiple Sclerosis, Neck Injury, Parkinson's Disease, Peripheral Neuropathy, Pulmonary Disease, Spinal Cord Injury, Stroke, Traumatic Brain Injury, Vestibular Disorders

Populations Tested:

• Spinal cord injury (SCI) (Van der Zee et al, 2014)
• Physical disabilities: musculoskeletal disease, traumatic brain injury, stroke, neuromuscular diseases, chronic pain, and heart failure (Van der Zee et al, 2010)
• Road accidents: fractures, traumatic brain injury, spinal cord injury, whiplash, other (Post et al, 2008)

Standard Error of Measurement (SEM):

Physical Disabilities: (Van der Zee et al, 2010; n = 47; mean age = 50.6 (11.8) years; mean time post diagnosis = 1.7 years; Dutch, Physical Disabilities)

• SEM= 4.4

Minimal Detectable Change (MDC):

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• MDC for entire group (n = 47)= 1.8 (SD= 0.14)
• MDC for individuals= 12.1 (SD= 0.96)

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Not Established

Test-retest Reliability:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Adequate test-retest reliability for most scale scores and sub-total score Participation: (ICC = 0.74)
• Fair to excellent reliability: Weighted kappa values for individual items varied from 0.22-0.82
  • Fair for three items, Moderate for seven, and almost perfect for three
• The mean percentage of exact agreement between individual items on a test-retest with two week latency period was 73.1% (range 56.6-89.1%)

Road Accidents: (Post et al, 2008; n = 197; mean age = 40.4 (15.8) years; mean time post injury = 2.2 (0.9) years; with residual disability at discharge; Dutch, Road Accidents)

• Adequate test-retest reliability between most domain scale scores (Kappa = 0.48-0.59) and excellent test-retest reliability between Knowledge & Mobility (Kappa = 0.63, 0.66).
• Adequate test-retest reliability between Activities & Participation sub-total scores (Kappa = 0.59, 0.56)
• Adequate test-retest reliability for IMPACT-S total scores (Kappa = 0.58).
• Excellent test-retest reliability for all domain scale scores (ICC = 0.75-0.92) except General tasks scale (ICC = 0.72).
• Excellent test-retest reliability for Activities & Participation sub-total scores (ICC = 0.93, 0.90).
• Excellent test-retest reliability for IMPACT-S total scores (ICC = 0.94).

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

SCI: (Van der Zee et al, 2014; n = 157; mean age = 50.6 (10.5); mean time post SCI = 25.3 (26.8) years; wheelchair dependent; Dutch, Spinal Cord Injury)

• Excellent internal consistency for IMPACT-S total score (Cronbach's alpha = 0.92)
• Excellent internal consistency for Activities subtotal score (Cronbach's alpha = 0.84)
• Excellent internal consistency for Participation subtotal score (Cronbach's alpha = 0.88)

Road Accidents: (Post et al, 2008, Road Accidents)

• Adequate internal consistency for Knowledge, General tasks, Communications, Interpersonal, Major life areas, Community life domain scale scores (Cronbach's alpha = 0.74-0.78) and excellent internal consistency for Mobility, Self-care, Domestic life domain scales scores (Cronbach's alpha = 0.81-0.89).
• Excellent internal consistency for Activities & Participation sub-total scores (Cronbach's alpha = 0.92, 0.92).
• Excellent internal consistency for IMPACT-S total score (Cronbach's alpha = 0.96).

Criterion Validity (Predictive/Concurrent):

Concurrent Validity:

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Adequate to excellent concurrent validity predicting Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) frequency, restrictions, and satisfaction scores (Spearman coefficient = 0.32-0.73)
• Excellent concurrent validity predicting World Health Organization Disability Assessment Schedule II (WHODAS II) total disability index scores (Spearman coefficient = 0.70-0.78)

Road Accidents: (Post et al, 2008, Road Accidents)

• Excellent concurrent validity predicting World Health Organization Disability Assessment Schedule II (WHODAS II) scores between corresponding & non-corresponding scales (Spearman coefficient = 0.64-0.78)

Construct Validity (Convergent/Discriminant):

Discriminant validity:

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Excellent discriminant validity correlation with paraplegia IMPACT-S total score (U = 73.8) and
• Excellent discriminant validity correlation with tetraplegia IMPACT-S total score (U = 63.3)

Convergent validity:

Road Accidents: (Post et al, 2008, Road Accidents)

• Adequate to excellent convergent validity for all domain scale scores (Spearman's coefficient = 0.34-0.75).
• Adequate to excellent convergent validity for Activities & Participation sub-total scores (Spearman's coefficient = 0.56-0.89).
• Adequate to excellent convergent validity for IMPACT-S total score (Spearman's coefficient = 0.63-0.97).

Content Validity:

Content validity was established based on correspondence to the ICF and pilot testing with a heterogeneous sample of motor vehicle collision survivors (n=11) and rehabilitation professionals (n=18). Validity and reliability statistics are based on postal surveys with a Dutch sample of 275 survivors of motor vehicle collisions. Validity and reliability statistics are reported for 9 domain scales, 2 subtotal scores for activities and participation, and a total score. (Magasi & Post, 2010)

Face Validity:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Not statistically assessed; however, majority of respondents consider this questionnaire to be a relevant measure to assess their participation.

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

• Not statistically assessed, however, 44.8% of all respondents considered the IMPACT-S, USER-Participation and WHODAS II instruments equally suitable to assess their participation, and 12.6% judged the IMPACT-S as best suitable.

Floor/Ceiling Effects:

Physical Disabilities: (Van der Zee et al, 2010, Physical Disabilities)

• Excellent: The total score did not show floor or ceiling effects

Outpatient Rehab Program : (Van der Zee et al, 2011, Outpatient Rehab Program)

• Excellent: No floor or ceiling effects.

SCI: (Van der Zee et al, 2014, Spinal Cord Injury)

Excellent: No floor and ceiling effects (0.0% and 0.0% respectively)

Responsiveness:

Not Established

Considerations:

• Empirical testing failed to support the hypothesized distinction between activities and participation, and there was limited patient involvement in the instrument's development (Magasi & Post, 2010).
• Even though an English version of the IMPACT-S is available, it has not yet been validated in English (Van der Zee et al, 2014). 
• IMPACT was designed as a 2-level instrument. Level 1 is the screener part (IMPACT-S) that covers all ICF activity and participation chapters and can be used as an independent measure. Level 2 is a series of modules but is still in the developmental phase (Post et al, 2008).
• Some patients reported that completing the questionnaire was confronting because it showed the many different disabilities that one may experience after trauma, but did not judge this negatively (Post et al, 2008).

Bibliography:

Magasi & Post. (2010). A comparative review of contemporary participation measures' psychometric properties and content coverage. Archives of Physical Medicine and Rehabilitation, 91(9), S17-28. doi: 10.1016/j.apmr.2010.07.011

Post, M., De Witte, L. P., Reichrath, E., Verdonschot, M. M., Wijlhuizen, G. J., & Perenboom, R. J. (2008). Development and Validation of IMPACT-S, an ICF-Based Questionnaire to Measure Activities and Participation. Journal of Rehabilitation Medicine, 40, 620-627. doi:10.2340/16501977-0223

Van der Zee, C. H., Post, M. W., Brinkhof, M. W., & Wagenaar, R. C. (2014). Comparison of the Utrecht Scale for Evaluation of Rehabilitation-Participation With the ICF Measure of Participation and Activities Screener and the WHO Disability Assessment Schedule II in Persons With Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 95, 87-93. doi: 10.1016/j.apmr.2013.08.236

Van der Zee, C. H., Priesterbach, A. R., van der Dussen, L., Kap, A., Schepers, V. P., Visser-Meily, J., & Post, M. W. (2010). Reproducibility of three self-report participation measures: The ICF Measure of Participation and Activities Screener, the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation. Journal of Rehabilitation Medicine, 42(8), 752-757.

Year published: 2008

Instrument in PDF Format: Yes

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Medical Outcomes Short-Form Health Survey

Link to instrument: http://www.sf-36.org

Acronym:

SF-36

Purpose:

The SF-36 is a generic patient-reported outcome measure aimed at quantifying health status, and is often used as a measure of health-related quality of life.

Description:

The SF-36 is a 36-item questionnaire that measures the physical and mental health constructs of health status. These constructs are measured through 8 subscales. The physical component (PCS) is made up of physical functioning (PF), role-physical (RP), bodily pain (BP), and general health (GH). The Mental component (MCS) is made up of vitality (VT), social functioning (SF), role-emotional (RE), and mental health (ME). Each of the 36 items is answered using a Likert-type scale and a 4-week recall period, with a total score of 0-100 possible. A higher score indicates better health status.

The SF-36 has been translated for over 50 different countries. The SF-36 can be a self- or computer-administered, or provided in an interview format in persons or over the phone for patients over the age of 14.

Area of Assessment: Activities of Daily Living

ICF Domain: Body Structure, Body Function, Activity, Participation

Domain: ADL, General Health

Assessment Type: Patient Reported Outcomes

Length of Test: 06 to 30 Minutes

Time to Administer:

5-10 minutes

Number of Items: 36

Equipment Required:

None

Training Required:

None

Type of training required: No Training

Cost: Not Free

Actual Cost:

Age Range: Adult: 18-64 years, Elderly adult: 65+

Populations Tested:

• Cancer of the head and neck

Standard Error of Measurement (SEM):

Minimal Detectable Change (MDC):

Minimally Clinically Important Difference (MCID):

Cut-Off Scores:

Normative Data:

Previously untreated, primary HNC:

 

(Funk G.F., Karnell L.H., Dawson C.J., et al, 1997; n = 180, mean age 58.9 (range, 20-85))

 

	US Norms	95% CI	HNC Pre-Surgery	95% CI
45-64 years (n = 39)
PCS	49.64	49.58-49.70	42.64	39.00-46.28
MCS	50.53	50.47-50.59	41.97	38.25-45.69
55-64 years (n = 51)
PCS	45.90	45.82-45.98	43.82	40.94-46.70
MCS	51.05	50.98-51.12	44.68	41.52-47.84
65-74 years (n = 48)
PCS	43.33	43.28-43.38	42.33	39.05-45.61
MCS	52.68	52.54-52.72	49.87	46.88-52.86

 

	HND pre-surgery(n=180)	SC	HNC, 6 months post-surgery (n=109)	SD	P-value
PCS	43.61	11.49	42.88	10.61	0.0470
MCS	45.05	11.97	47.19	11.82	0.1463

 

General Population:

 

(Ware J.E., Kosinski M., Keller S.D., 1994)

• General population mean for SF-36 component scores (not specific to head and neck cancer) = 50 (SD, 10)

Test-retest Reliability:

Interrater/Intrarater Reliability:

Internal Consistency:

Patients undergoing surgery for oral or oropharyngeal SCCA:

 

(Rogers S., Humphris G., Lowe D., Brown J., Vaughan E., 1998; n = 48, mean age (SD), 61 (12))

 

Subscale	Cronbach's alpha
Physical functioning	0.95
Role limitation, physical	0.92
Role limitation, mental	0.86
Social functioning	0.77
Mental health	0.78
Energy/Vitality	0.72
Pain	0.81
General health perception	0.79

 

Laryngeal cancer (Italian version):

 

(Mosconi P., Cifani S., Crispino S., Fossati R., Apolone G., 2000; n = 165, 64 (9.2), patients 0-262 months post-treatment)

 

Subscale	Cronbach's alpha
Physical functioning	0.88
Role limitation, physical	0.83
Role limitation, mental	0.84
Social functioning	0.91
Mental health	0.81
Energy/Vitality	0.81
Pain	0.85
General health perception	0.69

Criterion Validity (Predictive/Concurrent):

Patients within 2 years of diagnosis for head and neck cancer:

 

(Karvonen-Gutierrez C.A., Ronis D.L., Fowler K.E., Terrell J.E., Gruber S.B., Duffy S.A., 2008; n = 495)

• Predictive Validity:
  • When controlling for demographic, health behavior and clinical variables, QOL as measured by the SF-36, the PCS score is significantly associated with survival (hazard ratio 0.86, 95% CI 0.80-0.93).
  • For every 5-point increase in the PCS score, the risk of death decreased 0.14 times.

Construct Validity (Convergent/Discriminant):

Patients with cancer of the upper aero digestive tract:

 

(Chen A.Y., Frankowski R., Bishop-Leone J., et al., 2001)

 

Construct validity of the MD Anderson Dysphagia Index (MDADI) was determined through correlating the subscales of the SF-36 and MDADI. (Spearman correlation coefficient, greater than 0.60 - strong correlation, 0.40-0.60 - moderate to substantial, less than 0.40 - weak)

 

	MDADI Subscales
SF-36 Subscales	Global	Emotional	Functional	Physical
Physical functioning	0.29	0.36	0.31	0.40
Role - physical	0.31	0.33	0.37	0.38
Bodily Pain	0.21	0.23	0.24	0.26
General Health	0.21	0.33	0.28	0.32
Vitality/Energy	0.34	0.50	0.45	0.52
Social Functioning	0.44	0.50	0.45	0.51
Role - Emotional	0.34	0.40	0.42	0.43
Mental Health	0.27	0.30	0.29	0.34
PCS	0.25	0.30	0.29	0.34
MCS	0.44	0.54	0.51	0.54

 

Patients with head and neck cancer who underwent selective or modified radical neck dissection:

 

(Taylor R.J., Chepeha J.C., Teknos T.N., Bradford C.R., Sharma P.K., Terrell J.E., Hogikyan N.D., Wolf G.T., Chepeha D.B., 2002; n = 54, patients had a minimum postoperative convalescence of 11 months) 

 

Convergent validity of the Neck Dissection Impairment Index (NDII):

(Spearmen or Pearson not specified)

Subscale	Correlation to NDII	P-value
Physical functioning	0.50	<0.001
Role limitation, physical	0.60	0.001
Role limitation, mental	0.59	0.001
Social functioning	0.62	0.001
Mental health	0.56	0.001
Energy/Vitality	0.44	0.001
Pain	0.32	0.001
General health perception	0.55	0.001

 

Patients undergoing surgery for oral or oropharyngeal SCCA:

 

(Rogers S., Humphris G., Lowe D., Brown J., Vaughan E., 1998)

 

Correlation between SF-36 and University of Washington Hand and Neck Questionnaire:

Subscale	Pearson's Correlation
Physical functioning	0.61, P<0.001
Role limitation, physical	0.66, P<0.001
Role limitation, mental	0.47, P<0.01
Social functioning	0.54, P<0.001
Mental health	-0.08
Energy/Vitality	0.43, P<0.01
Pain	0.61, P<0.001
General health perception	0.42, P<0.01

 

(Rogers S.N., Lowe D., Brown J.S., Vaughan E.D., 1998)

• Spearman correlation coefficients:
  • SF-36 with European Organization for Research and Treatment of Cancer (EORTC): r = 0.83
  • SF-36 with University of Washington Head and Neck Disease-Specific Measure (UW-QOL): r = 0.80

Laryngeal cancer (Italian version):

 

(Mosconi P., Cifani S., Crispino S., Fossati R., Apolone G., 2000)

• Convergent Validity - within subscale coefficients all higher than 0.40
• Discriminant Validity - higher item-scale correlations found within the subscale than between the subscales

Content Validity:

Face Validity:

Floor/Ceiling Effects:

Patients undergoing surgery for oral or oropharyngeal SCCA:

 

(Rogers S., Humphris G., Lowe D., Brown J., Vaughan E., 1998)

• No floor or ceiling effects

Responsiveness:

Laryngeal cancer (Italian version):

 

(Mosconi P., Cifani S., Crispino S., Fossati R., Apolone G., 2000)

 

Subscale	Effect Size
Physical functioning	0.45
Role limitation, physical	0.78
Role limitation, mental	0.40
Social functioning	0.66
Mental health	0.29
Energy/Vitality	0.04
Pain	0.88
General health perception	0.74
Component Summary Scores
Physical	1.1
Mental	0.09

(reference: first level of treatment extent, 0.60 indicates an important magnitude of change)

Considerations:

Bibliography:

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Vestibular Rehabilitation Benefits Questionnaire

Acronym:

VRBQ

Purpose:

Designed by A. Morris, M. Lutman, and L. Yardley (2009), the Vestibular Rehabilitation Benefit Questionnaire (VBRQ) was designed to assess the outcome of individuals undergoing vestibular rehabilitation.  The prototype questionnaire was developed based on the literature, patient interview and items from other subjective measures of dizziness (DHI, VHQ, DFI, UCLA-DQ, VADL, VSS, and the DBS).  The prototype questionnaire was designed to measure the effect of dizziness on quality of life and included 36 items.  The tool was validated against a set of established questionnaires; the DHI, VSS-sf, and the SF-36.  The tool then was refined down to what is currently known and recognized as the 22- item VRBQ. The VBRQ measures the difference between the individual's current state of symptoms and quality of life as compared to a state that is normal for the individual.  The VBRQ is a concise and psychometrically robust tool that subjectively addresses the primary aspects of dizziness impact on quality of life.   

Description:

The Vestibular Rehabilitation Benefit Questionnaire is a 22-item paper/pencil design subjective questionnaire utilized clinically to assess the outcome of individual's undergoing vestibular rehabilitation programs.  The tool is designed to be a pre and post test measure to determine the effectiveness of physical therapy intervention on an individual's symptoms and the impact of those symptoms on quality of life.  The 22-item questionnaire consists of items falling into three subscale categories: dizziness and anxiety (six items), motion-provoked dizziness (five items), and quality of life (11 items). The score for the entire tool ranges from 0 to 100%; zero percent indicating no deficit and 100% indicating significant deficit as compared to normal state.  Any score above zero percent indicates a presence of symptoms, loss of function or decreased quality of life.  Scoring of the VRBQ requires scoring each item using the scoring template, adding the relevant item scores together to find the subscale scores and then multiplying the raw subscale scores by the value in the % deficit box for each subscale score (see scoring sheet attached to tool).  If however, the quality of life subscale score is less than zero (a negative score), then the score must be raised to zero.  The scoring of the VRBQ requires the use of the scoring template attached to the actual tool itself.  The questionnaire and method of scoring and interpretation can be found at http://ift.tt/1VgEL7L. 

Area of Assessment: Activities of Daily Living, Life Participation, Quality of Life, Social Relationships, Vestibular

Body Part: Head

ICF Domain: Body Function, Activity, Participation

Domain: ADL, Emotion, General Health, Motor, Sensory

Assessment Type: Patient Reported Outcomes

Length of Test: 06 to 30 Minutes

Time to Administer:

20 minutes

Number of Items: 22-item self report questionnaire

Equipment Required:

The questionnaire and scoring template

Training Required:

None

Type of training required: No Training, Reading an Article/Manual

Cost: Free

Actual Cost:

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Vestibular Disorders

Populations Tested:

Adults undergoing vestibular rehabilitation

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Clinically meaningful change Summary scores:

Total = 7%

Quality of life = 9%

Symptoms =  6%

Symptom subscales:

Dizziness = 9%

Anxiety= 5%

Motion-provoked dizziness = 13%

Minimum clinically meaningful change is based on 2SD of the mean score change on repetition over 24 hours (95% confidence)

Cut-Off Scores:

Scores range from 0-100% (zero indicating no impact from dizziness and 100% indicating maximal impact from dizziness)

Normative Data:

Not Established

Test-retest Reliability:

Strong interclass correlations for the VRBQ total (ICC = 0.92); dizziness (ICC = 0.99); anxiety (ICC = 0.99); motion-provoked dizziness (ICC = 0.98); quality of life (ICC = 0.94). 

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

VRBQ Total Cronbach's α = 0.73; dizziness α = 0.89; anxiety α = 0.74; motion- provoked dizziness α = 0.91 and quality of life α = 0.92

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

The VRBQ total is moderately correlated to the DHI total score (r = 0.44) and to the VSS total score (r = 0.45). Weak correlation to the SF-36 mental and physical subscale scores (r = -0.27) and (r = -0.33) respectively.

Content Validity:

Not Established

Face Validity:

Not Established

Floor/Ceiling Effects:

Not Established

Responsiveness:

The VRBQ shows effect sizes in the range of 0.35-0.67 indicating a moderate effect.

Considerations:

Familiarization with the tool and scoring template prior to use would be beneficial.

Bibliography:

Alghwiri, A. A., Marchetti, G. F., et al. (2011). "Content Comparison of Self-Report Measures Used in Vestibular Rehabilitation Based on the International Classification of Functioning, Disability and Health." Physical Therapy 91(3): 346-357.

Cohen, H. S. (2011). "Assessment of functional outcomes in patients with vestibular disorders after rehabilitation." NeuroRehabilitation 29(2): 173-178. Find it on PubMed

Meldrum, D., Herdman, S., et al. (2012). "Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial." BMC Ear Nose Throat Disord 12(1): 3. Find it on PubMed

Morris, A. E., Lutman, M. E., et al. (2008). "Measuring outcome from Vestibular Rehabilitation, Part I: Qualitative development of a new self-report measure." Int J Audiol 47(4): 169-177. Find it on PubMed

Morris, A. E., Lutman, M. E., et al. (2009). "Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure." Int J Audiol 48(1): 24-37. Find it on PubMed

Year published: 2009

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Vestibular Activities and Participation Measure

Acronym:

VAP

Purpose:

The Vestibular Activities and Participation Measure (VAP) was developed to assess the extent of activity limitations and participation restrictions created by vestibular disorders.  The tool specifically targets areas of activity and participation as outlined by the ICF.  The tool was designed as a disease-specific, self-report measure of activity limitations and participation restrictions for individuals with vestibular impairment that corresponds directly to the ICF.  It was designed to provide clinicians and researchers with an instrument that can be easily used for specific purposes and clearly compared to other instruments.  It can also be used to reflect patients' status.  The VAP can be used for assessment, intervention planning and outcome evaluation in individuals with vestibular disorders.   

Description:

The Vestibular Activities and Participation Measure (VAP) is a 34-item self-report questionnaire that asks the individual to evaluate the effect of dizziness and/or balance problems on their ability to perform activity and participation tasks.  The responses range from none (0 points), moderate (2 points), severe (3 points), unable to do (4 points) to not applicable.  The total score for the VAP is obtained by calculating the average of the item scale values after excluding the "not applicable" items. 

Area of Assessment: Activities of Daily Living, Balance Vestibular, Functional Mobility, Gait, Life Participation, Occupational Performance, Self-Efficacy, Social Relationships, Social Support, Vestibular

Body Part: Not Applicable

ICF Domain: Activity, Participation

Domain: ADL, Cognition, Emotion, Motor

Assessment Type: Patient Reported Outcomes

Length of Test: 06 to 30 Minutes

Time to Administer:

5-10 min

Number of Items: 34-item self report questionnaire

Equipment Required: The questionnaire

Training Required:

None

Type of training required: No Training

Cost: Free

Actual Cost: Difficulty accessing the tool and scoresheet; must access through the original article.  

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Vestibular Disorders

Populations Tested: Adults complaining of dizziness and imbalance (peripheral vestibular disorders, central vestibular disorders and unspecified dizziness)

Standard Error of Measurement (SEM):

(Algwhiri A A, et al, 2011)

• The standard error of measurement for the VAP = 0.21

Minimal Detectable Change (MDC):

(Algwhiri A A, et al, 2011)

• The MDC₉₅ for the VAP = 0.58, which describes the amount of change in patient status required to exceed chance variation. 

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Not Established

Test-retest Reliability:

(Algwhiri A A, et al, 2011)

• High test-retest reliability after 2 hours utilizing for the concordance correlation coefficient: Total score (rc = 1); functional subscale score (rc = 0.87); ambulatrion subscale score (rc = 0.95); and instrumental subscale score (rc = 0.97).

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

(Algwhiri A A, et al, 2011)

• High internal consistency for total score (ɑ = 0.97); functional subscale score (ɑ = 0.92); ambulation subscale (ɑ = 0.96); and instrumental subscale (ɑ = 0.91)

Criterion Validity (Predictive/Concurrent):

(Algwhiri A A, et al, 2011)

• A significant strong correlation (p = 0.70; p < 0.05) between VAP and the World Health Organization Disability Assessment Schedule II (WHODAS II).
• Moderate to strong correlations (p = 0.54-0.74) between VAP total score and the DHI dimensions and total scores. Strong correlation between VAP and DHI total score (p = 0.74).

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

(Algwhiri A A, et al, 2011)

• Use of Delphi technique in the development of the VAP contributed to good content validity. 

Face Validity:

(Algwhiri A A, et al, 2011)

• Good face validity as determined by a group of experts and by 39 of the 55 candidate items retrieved from current instruments that have been previously validated in individuals with vestibular disorders.   

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

Newly developed tool with limited research backing to this point, but a very comprehensive initial study.   

Bibliography:

Alghwiri, A. A., Whitney, S. L., et al. (2012). "The development and validation of the vestibular activities and participation measure." Arch Phys Med Rehabil 93(10): 1822-1831. Find it on PubMed

Year published: 2012

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Vestibular Disorders Activities of Daily Living Scale

Acronym:

VADL

Purpose:

The Vestibular Disorders Activities of Daily Living Scale was developed to assess self-perceived disablement in individuals with vestibular impairment. The scale evaluates the effects of vertigo and balance disorders on independence in everyday activities of daily living.   The tool is designed to be useful for evaluating functional limitation and perceived handicap and disability before and after therapeutic intervention.  The tool is also designed to assist individuals in becoming more realistic in the understanding of their own capabilities. The tool was designed to be more directed to specific basic and instrumental activities of daily living. 

Description:

The Vestibular Disorders Activities of Daily Living Scale (VADL) is a 28 item self report questionnaire that is broken down into 3 subscales: functional, ambulatory, and instrumental.  The functional subscale evaluates the individual's perception of basic self-maintenance tasks; the ambulatory subscale evaluates perception of mobility related skills and the instrumental subscale looks at self-perception in higher-level more socially complex tasks. The questionnaire requires individuals to rate their self-perceived disablement level on a scale that ranges from 1 (independent) to 10 (too difficult, no longer performed). 

Area of Assessment: Activities of Daily Living, Functional Mobility, Gait, Life Participation, Self-Efficacy, Social Relationships, Social Support, Vestibular

Body Part: Not Applicable

ICF Domain: Body Function, Activity, Participation

Domain: ADL

Assessment Type: Patient Reported Outcomes

Length of Test: 06 to 30 Minutes

Time to Administer:

5-10 min

Number of Items: 28-item self report questionnaire

Equipment Required: The questionnaire

Training Required:

None

Type of training required: No Training

Cost: Free

Actual Cost:

Difficulty accessing the tool and scoresheet; must access through the original article.  

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Vestibular Disorders

Populations Tested: Adults complaining of dizziness, vertigo and imbalance (peripheral vestibular disorders, BPPV)

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Not Established

Test-retest Reliability:

High test-retest reliability after 2 hours utilizing for the concordance correlation coefficient: Total score (rc = 1); functional subscale score (rc = 0.87); ambulation subscale score (rc = 0.95); and instrumental subscale score (rc = 0.97).

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

High internal consistency for total score (ɑ = 0.97); functional subscale score (ɑ = 0.92); ambulation subscale (ɑ = 0.96); and instrumental subscale (ɑ = 0.91)

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

There is moderate correlation between the VADL Scale score and the DHI total score (Spearman p = 0.66, p < 0.001)

Significant difference found between controls and patients (p < 0.0001)

No difference between individuals with BPPV and chronic vestibulopathy

No correlation between VADL scores and vertigo intensity (10-point scale)

Weak correlation between VADL total scores and vertigo frequency (10-point scale): (Spearman's p p = 0.32, P = 0.04). Weak correlation between VADL instrumental scores to vertigo frequency: (Spearmans p p = 0.42, P = 0.004).

Weak statistically significant relationships found between SOT conditions 5 and 6 and VADL total scores and all subscores and between SOT composite score and total, functional and instrumental scores. 

Content Validity:

Not Established

Face Validity:

Good face validity as determined by a group of experts

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

Limited psychometric properties should be considered before use.

Bibliography:

Alghwiri, A. A., Marchetti, G. F., et al. (2011). "Content Comparison of Self-Report Measures Used in Vestibular Rehabilitation Based on the International Classification of Functioning, Disability and Health." Physical Therapy 91(3): 346-357.

Aratani, M. C., Perracini, M. R., et al. (2010). "Disability rank in vestibular older adults." Geriatrics & gerontology international 11(1): 50-54.

Cohen, H. S. and Kimball, K. T. "Measurement Tools Analysis: Vestibular Disorders Activities of Daily Living (VADL)." 

Cohen, H. S. and Kimball, K. T. (2000). "Development of the vestibular disorders activities of daily living scale." Arch Otolaryngol Head Neck Surg 126(7): 881-887. Find it on PubMed

Cohen, H. S. and Kimball, K. T. (2002). "Improvements in path integration after vestibular rehabilitation." J Vestib Res 12(1): 47-51. Find it on PubMed

Cohen, H. S. and Kimball, K. T. (2003). "Increased independence and decreased vertigo after vestibular rehabilitation." Otolaryngol Head Neck Surg 128(1): 60-70. Find it on PubMed

Cohen, H. S. and Kimball, K. T. (2004). "Decreased ataxia and improved balance after vestibular rehabilitation." Otolaryngol Head Neck Surg 130(4): 418-425. Find it on PubMed

Cohen, H. S., Kimball, K. T., et al. (2000). "Application of the vestibular disorders activities of daily living scale." Laryngoscope 110(7): 1204-1209. Find it on PubMed

Cohen, H. S., Wells, J., et al. (2003). "Driving disability and dizziness." J Safety Res 34(4): 361-369. Find it on PubMed

Duracinsky, M., Mosnier, I., et al. (2007). "Literature review of questionnaires assessing vertigo and dizziness, and their impact on patients' quality of life." Value in health 10(4): 273-284.

Maskell, F., Chiarelli, P., et al. (2006). "Dizziness after traumatic brain injury: overview and measurement in the clinical setting." Brain Inj 20(3): 293-305. Find it on PubMed

Mira, E. (2008). "Improving the quality of life in patients with vestibular disorders: the role of medical treatments and physical rehabilitation." Int J Clin Pract 62(1): 109-114. Find it on PubMed

Year published: 2000

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University of California Los Angeles Dizziness Questionnaire

Acronym:

UCLA-DQ

Purpose:

Designed by Honrubia et al., (1996), The University of California Los Angeles Dizziness Questionnaire (UCLA-DQ) was designed to collect information on the severity, frequency and fear of dizziness and its effect on quality of life and activities of daily living.  The goal in the tool development was to develop a tool that was easy to understand, quick to administer and that was equally applicable to all dizzy patients.  The tool was designed to provide the clinician significant information about the impact of dizziness on the patient's life.  The tool was designed as a screening tool that provides clear, concise information in regards to the impact that dizziness has on an individual's everyday life.  The UCLA-DQ is designed to address the physical, emotional and functional aspects of dizziness in a five question,  easy to administer, easy to interpret questionnaire

Description:

The UCLA-DQ is a five item forced-choice, self-report subjective questionnaire.  The five questions measure dizziness frequency, severity, fear and impact on quality of life and activities of daily living.  The answer choices on the 5-point Likert scale are presented in ascending order from 1, indicating least severe, to 5, indicating most severe.  The score ranges from 5-25 with higher scores indicating most severity.

If an individual does not have dizziness at all, 0 points are given. 

Area of Assessment: Activities of Daily Living, Life Participation, Quality of Life, Vestibular

Body Part: Head

ICF Domain: Body Function, Activity, Participation

Domain: ADL, Emotion, Sensory

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less

Time to Administer:

5 minutes

Number of Items: 5-item self report questionnaire

Equipment Required:

Questionnaire

Training Required:

None

Type of training required: No Training

Cost: Free

Actual Cost:

Difficulty accessing the tool

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Vestibular Disorders

Populations Tested:

Adults complaining of dizziness (BPPV, peripheral vestibular disorders, central vestibular disorders and migraine related dizziness)

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Scores range from 5-25; 5 being the least severe and 25 being most severe, with no cut-off score established.

(Kammerlind, et al, 2011)

• 0 point given if an individual does not experience dizziness at all.

Normative Data:

Not Established

Test-retest Reliability:

Not Established for the original version; (Kammerlind et al., 2011) Test-retest reliability (ICC, 0.089) in subjects with remaining symptoms after AUVL in the Swedish translation version of the scale. (Perez et al., 2001) Cronbach's ɑ = 0.8236 for the Spanish version of the questionnaire

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

Not Established

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

(Perez et al., 2001) A significant relationship (p < 0.01) was found between item one, frequency of dizziness, item two, severity of dizziness and the other 3-items on the questionnaire. Factor analysis identified a two-factor solution for the UCLA-DQ that accounts for 75.43% of the variance Excellent correlation between vestibular handicap factor and DHI emotional (DHIe) subscale r = 0.927 p < 0.001, and DHI functional subscale (DHIf) r = 0.743 p < 0.001. Adequate correlation between vestibular handicap factor and the DHI physical (DHIp) subscale r = 0.317 p < 0.001 Excellent correlation between vestibular disability factor and the DHI emotional r = 0.912 p  < 0.001 Poor correlation between vestibular disability factor and the DHIf subscale 0.425 p < 0.001 Adequate correlation between vestibular disability factor and DHI physical subscale r = 0.714 p < 0.001

Content Validity:

Not Established

Face Validity:

Not Established

Floor/Ceiling Effects:

Not Established

Responsiveness:

Not Established

Considerations:

Limited psychometric properties should be considered before use.

Has reliably been translated into Spanish

Bibliography:

Honrubia, V., Bell, T. S., et al. (1996). "Quantitative evaluation of dizziness characteristics and impact on quality of life." Am J Otol 17(4): 595-602. Find it on PubMed

Kammerlind, A. S., Ledin, T. E., et al. (2011). "Recovery after acute unilateral vestibular loss and predictors for remaining symptoms." Am J Otolaryngol 32(5): 366-375. Find it on PubMed

Perez, N., Garmendia, I., et al. (2001). "Factor analysis and correlation between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life scales." Acta Otolaryngol Suppl 545: 145-154.

 

Year published: 1996

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Supine to Stand Test

Acronym:

Purpose:

To assess a person's ability to transition from a supine postition to a standing position. 

Description:

Measures the amount of time it takes to rise to standing from the supine position from a mat, not from the floor. A standardized protocol for this exam has not been published.

Area of Assessment: Activities of Daily Living, Functional Mobility

Body Part: Not Applicable

ICF Domain: Activity

Domain: ADL, Motor

Assessment Type: Performance Measure

Length of Test: 05 Minutes or Less

Time to Administer:

Less than 5 minutes

Number of Items: 1

Equipment Required:

• Timer
• Raised mat

Training Required:

None

Type of training required: No Training

Cost: Free

Actual Cost:

$0

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Geriatrics, Movement Disorders, Parkinson's Disease

Populations Tested:

• Geriatric persons living in a congregate housing facility
• Parkinson's Disease

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Congregate Housing Facility:

(Alexander et al, 2000; n = 116; mean age = 82.1 (6.6); residents requiring assistance with at least one (transfer, walking, bathing, toileting)

• Mean time (seconds) to complete supine to stand: 15.2(18.1) seconds
• 6 of 116 unable to complete (5%)

Parkinson's Disease:

(Schenkman et al, 2011; n = 186; no mean age/range given)

• Mean time (seconds) to complete supine to stand by H&Y Stage
  • H&Y1 - 1.5 = 3.35 (0.92); Range = 2.44 - 4.53
  • H&Y2 = 3.36 (2.02); Range = 1.85 - 17.62
  • H&Y2.5 = 4.68 (2.01); Rang e=1.81 - 11.53
  • H&Y3 = 6.42 (4.16); Range = 1.75 - 19.71

Parkinson's Disease:

(Schenkman et al, 1998; Exercise group: n = 23 subjects with PD; mean age = 70.6 (6.2); H&Y Stage 2: H&Y n = 7; H&Y Stage 2.5: n = 6; H&Y Stage 3: n = 10; Control group: n = 23 subjects with PD; mean age = 71.2(7.3); H&Y Stage 2: H&Y n = 3; H&Y Stage 2.5: n = 6; H&Y Stage 3: n = 14)

• Mean Supine to Stand time at baseline (sec) = 6.5 (3.7)
• Mean Supine to Stand time at baseline (sec)= 9.4 (7.6)

(Schenkman et al, 2000; n = 56 community dwelling adults with PD; mean age = 70.7(7.4); H&Y Stages 2 and 3; n = 195 community dwelling adults without PD; mean age = 71.4(5.0))

• Mean Supine to Stand time (sec) = 7.2 (3.7)
• Mean Supine to Stand time (sec) = 5.2 (2.0)

Test-retest Reliability:

Geriatric:

(Alexander et al, 2000)

• Excellent test retest reliability for time to complete supine to stand (ICC = 0.9)

Interrater/Intrarater Reliability:

Not Established

Internal Consistency:

Not Established

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

Not Established

Face Validity:

Not Established

Floor/Ceiling Effects:

Parkinson's Disease:

 

(Schenkman et al, 2011)

• Schenkman report the Supine to Stand Test only revealed limitation in H&Y Stage 3 (not responsive in H&Y Stages 1 - 2.5; not tested in H&Y 4 and 5) or with UPDRS motor scores > 45

Responsiveness:

Parkinson's Disease:

(Shenkman et al, 1998)

• Exercise group: Mean Supine to Stand time change score(sec): -0.6 (2.09)
• Control group: Mean Supine to Stand time change score (sec): -1.01 (2.74)
• There was no significant difference between the two groups suggesting that the supine to stand measure may not be responsive to the spinal flexibility intervention

(Shenkman et al, 2011)

• Shenkman reports the Supine to stand test only revealed limitations in H&Y Stage 3 (not responsive in H&Y Stages 1-2.5; not tested in H&Y 4 and 5) or with UPDRS motor scores > 45
  • Participants at H&Y Stage 3 were on average twice as slow as participants in earlier H&Y stages
  • Large variability of H&Y stage 3 scores suggests that not all persons in H&Y stage 3 will experience limitation on the supine to stand test

Considerations:

At this point there is limited testing of the psychometric properties of the supine to stand test. Reliability testing is limited to one study in a disabled geriatric population. There are no reliability and validity studies in persons with Parkinson's disease. However, normative data in PD has been published and responsiveness examined for H&Y Stages 1-3. This test may have ceiling effects in persons in the early stages of PD (H&Y 1-2.5), appears responsive in the mid-stages (H&Y 3) and has not been tested in the later stages (H&Y 4 and 5)

Bibliography:

Alexander, N. B., Galecki, A. T., et al. (2000). "Chair and bed rise performance in ADL-impaired congregate housing residents." J Am Geriatr Soc 48(5): 526-533. Find it on PubMed

Schenkman, M., Cutson, T. M., et al. (1998). "Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial." J Am Geriatr Soc 46(10): 1207-1216. Find it on PubMed

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease." Phys Ther 91(9): 1339-1354. Find it on PubMed

Instrument in PDF Format: Yes

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Unified Dyskinesia Rating Scale

Link to instrument: Link to UDRS

Acronym:

(UDysRS)

Purpose:

Purpose of the scale: (Goetz C et al, 2008, n = 70; mean age = 65.2 (8.9) years; mean duration of PD = 13.3 (8.5) years; HY stage (2-4) years)

Assess "On-Dyskinesia" ("choreic and dystonic movements explained to the patient as jerking or twisting movement that occurs when your medicine is working") and off- Dystonia ( explained to patient as "spasms or cramps that can be painful and occur when your Parkinson's disease medications are not taken or are not working") in individuals with treated Parkinson's disease (PD).

Description:

Description of the scale: (Goetz C et al, 2008) There are 2 sections: Historical and Objective. Historical section has Part 1 and 2, which are further subdivided into 1A,1B and 2A,2B.  Objective section has 2 subdivisions (parts 3 and 4) 

Part 1A: Is administered by the examiner. Examiner determines the total amount of time patient experiences "on dyskinesia" within past week and including the day of examination. The amount of time spent is then rated on a scale from 0-4.

• 0: Normal- No dyskinesia
• 1: Slight- < 25% of on-time
• 2: Mild- 26-50% of on-time
• 3: Moderate- 51-75% of on-time
• 4: Severe- > 75% of on-time

Part 1B: Is a patient or caregiver questionnaire with questions analyzing the impact of dyskinesia specifically over the past week on patients' activities of daily living such as speech, chewing and swallowing, eating tasks, dressing, hygiene, handwriting, doing hobbies and other activities, walking and balance, public and social settings, exciting or emotional settings. Impact of dyskinesia in each of this situation is assessed using 0-4 scale (0: Normal; 1:Slight; 2:Mild; 3:Moderate; 4:Severe)

Part 2A: Examiner asks question concerning the duration of time in a day patient experienced off dystonia within past week and including the day of examination. The duration is then rated on a scale from 0-4. (0 = Never 1 = Less than 30 minutes a day 2 = Less than 60 minutes a day 3 = Less than 2 hours a day 4 = Greater than 2 hours a day).

Part 2B: Is a patient or caregiver questionnaire and assesses the impact of off-period dystonia and pain associated with it on patient's daily activities. The impact is then scored on a scale of 0-4 (0: Normal, 1: Slight; 2: Mild; 3: Moderate and 4: Severe)

Objective section or Parts 3 & 4

Examiner observes patient directly or using videotape and rates the Intensity of the Impairment and the Disability associated with the patient's dyskinesia and dystonia during communication, drinking from a cup, dressing, and walking. The impairment ratings (intensity scale) is further assessed for each of the following seven body parts: Face, Neck, Arm/shoulder (right and left), Trunk, and Leg/hip (right and left)

ICF Domain: Body Structure, Body Function, Activity, Participation

Length of Test: 06 to 30 Minutes

Time to Administer:

15 minutes (Colosimo C et al, 2010)

Number of Items: 15 items under Historical Section: (Goetz C et al, 2008); Part 1 A (1 question); Part 1B (10 questions); Part 2A (1 question); Part 2B (3 questions); 11 items under Objective or Part 3

Equipment Required:

(Goetz C et al, 2008)

• Picture (Cookie Thief Drawing recommended)
• Cup filled with 4 oz water
• Lab coat
• Chair

Training Required:

Yes, A DVD-based teaching program is available which includes examples of patients in the form of videos which help in assessing the objective part of the scale and it also includes a certification exercise (Goetz C et al, 2009, n = 70; mean age = 65.2 (8.9) years; mean duration of PD = 13.3 (8.5) years; HY stage (2-4) years)

 

DVD available at: http://ift.tt/1VgEHF5

Type of training required: Reading an Article/Manual, Training Course

Actual Cost:

Unknown

Diagnosis: Geriatrics

Populations Tested:

• Parkinson's Disease

Standard Error of Measurement (SEM):

Not Established

Minimal Detectable Change (MDC):

Not Established

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Not Established

Normative Data:

Parkinson's Disease:

(Suppa et al 2011 {n = 20, 9 with dyskinesias (mean age 63 (6.8) years, mean UPDRS = 18 (7.3) on meds & UPDRS = 29 (8.8) off meds, mean disease duration = 9 (5.1), H&Y stage 1.5-3); and 11 without dyskinesias (mean age = 62 (8.1), mean UPDRS = 16 (4.6) on meds & UPDRS 26 (8.5) off meds, mean disease duration = 5 (3.7), H & Y 2-3)

• Clinical evaluation of peak dose dyskinesias in PD patients with levodopa induced dyskinesia. UDysRS scores ranged from 17-56, with mean score = 30 (12.8)

Test-retest Reliability:

Parkinson's Disease:

(Goetz C et al, 2011, n = 39; mean age = 63.7 (9.7) years; mean PD duration = 14.1(5.0) years)

• Excellent test-retest reliability (ICC = 0.822-0.513)

Interrater/Intrarater Reliability:

Parkinson's Disease:

(Goetz C et al, 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias) )

• Excellent interrater reliability (ICC = 0.87) for impairment section
• Excellent interrater reliability (ICC = 0.91) for summary disability
• Excellent interrater reliability (ICC = 0.89) for total objective score
• Excellent intrarater reliability (ICC = 0.91) for impairment section
• Excellent intrarater reliability (ICC = 0.84) for summary disability
• Excellent intrarater reliability (ICC = 0.90) for total objective score
• Interrater reliability for impairment and disability items ranged from fair (kappa 0.4 to 0.59) to excellent (kappa > 0.8); with excellent total score reliability
• Intrarater reliability for impairment and disability items ranges from fair (kappa 0.59) to excellent (kappa > 0.8), with excellent total score reliability

Internal Consistency:

Parkinson's Disease:

(Goetz C et al, 2008)

• Excellent internal consistency (Cronbach's alpha > 0.92) or subjective and objective rating section.

Criterion Validity (Predictive/Concurrent):

Not Established

Construct Validity (Convergent/Discriminant):

Not Established

Content Validity:

Parkinson's Disease:

(Goetz et al, 2011; n = 39; mean age 63.7 years, mean duration of PD = 14.1 years)

• Temporal stability of UDysRS scores across an 8-hour observation period during clinical "on" and "off" states. Provides evidence that UDysRS is highly stable for individual patient's ON and OFF periods, thus is a reliable estimate of score

Face Validity:

Parkinson's Disease:

(Goetz C et al, 2008; n = 70, H & Y stage 2-4, Range of dyskinesias (15 = no dyskinesia, 20 = mild, 20 = moderate, 15 = severe dyskinesias)

• Scale developed by a team of 20 international movement disorder experts (Goetz, 2008)
• Excellent correlation between severity classification by the dyskinesia scale development team and patient self report (r = 0.81, p < 0.005)

Floor/Ceiling Effects:

Not Established

Responsiveness:

Parkinson's Disease:

(Goetz et al, 2013 (n = 61 with PD and dyskinesias, H & & stages 1-4, mean duration of disease = 9.0 (3.5) years)

• Able to detect significant treatment effects of Amantadine on dyskinesia, with Effect size = 0.138 (at 4 and 8 weeks compared to baseline scores); Better ability to measure change than a range of other dyskinesia rating scales and ADL rating scales

Considerations:

The test is developed by the researchers of the Movement Disorder Society. (Goetz C et al, 2008)

According to the Movement Disorder Society task force: (Colosimo C et al, 2010)

• Abnormal Involuntary Movement Scale and Rush Dyskinesia Rating scale are currently recommended scales to assess dyskinesia in Parkinson's disease.
• Although UDysRS has excellent reliability, it is a relatively new assessment tool and has not been used by other researchers outside the ones who developed the test, thus needing further research.
• Responsiveness testing to an intervention; convergent, discrimination and content validity have not been determined

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Bibliography:

Colosimo, C., Martinez-Martin, P., et al. (2010). "Task force report on scales to assess dyskinesia in Parkinson's disease: critique and recommendations." Movement Disorders 25(9): 1131-1142. Find it on PubMed

Goetz, C. G., Nutt, J. G., et al. (2008). "The Unified Dyskinesia Rating Scale: presentation and clinimetric profile." Movement Disorders 23(16): 2398-2403. Find it on PubMed

Goetz, C. G., Nutt, J. G., et al. (2009). "Teaching program for the Unified Dyskinesia Rating Scale." Movement Disorders 24(9): 1296-1298. Find it on PubMed

Goetz, C. G., Stebbins, G. T., et al. (2013). "Which Dyskinesia Scale Best Detects Treatment Response?" Movement Disorders.

Goetz, C. G., Stebbins, G. T., et al. (2011). "Temporal stability of the Unified Dyskinesia Rating Scale." Movement Disorders 26(14): 2556-2559. Find it on PubMed

Suppa, A., Marsili, L., et al. (2011). "Lack of LTP-like plasticity in primary motor cortex in Parkinson's disease." Experimental neurology 227(2): 296-301. Find it on PubMed

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