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Background: The Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) was designed to be more sensitive to mild motor severity than the Unified Parkinson's Disease Rating Scale (UPDRS). Objective: To test whether MDS‐UPDRS Part III items provide increased sensitivity to mild motor severity when compared to the same items of the UPDRS in de novo PD patients. Method: Using a sample of 129 de novo PD patients assessed at one time point simultaneously with both scales, we compared the scale's scores on the 17 items measuring the same motor function. The scaling anchors for the MDS‐UPDRS were Slight, Mild, Moderate and Severe, and for the UPDRS were Mild, Moderate, Severe and Marked. Using Classical Test Theory (CTT) we compared the distributions of the scaling anchors from the individual items. Using Item Response Theory (IRT), we examined the sensitivity of the scaling anchors from each scale to the latent‐trait measurement of overall parkinsonian motor severity. Results: There was 2193 observations of individual scaling anchors from the 17 items in both scales. The CTT approach revealed frequent floor effects with only the item assessing Gait demonstrating a significance difference in the scaling distribution between the scales (P = 0.005). The IRT analyses revealed similar levels of sensitivity to the latent trait of PD motor function. Conclusion: These results do not support increased sensitivity of MDS‐UPDRS over the UPDRS for assessing mild motor severity in de novo PD patients, with significant difference in the scaling only for the item assessing gait. [ABSTRACT FROM AUTHOR]

Background: Physical function is a common target of rehabilitation intervention to improve disability and physical activity after dysvascular lower‐limb amputation (LLA); yet, the influence of psychosocial factors on physical activity is unclear. Objective: To identify psychosocial factors with potential to influence clinically relevant measures of physical activity, physical function, and disability in light of participants' narratives. Design Convergent mixed‐methods. Setting: General community. Participants: Twenty participants with dysvascular LLA were enrolled if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and were between 45 and 88 years old. Intervention: Not applicable. Main Outcome Measures: Quantitative data included physical activity (activPAL; steps/d), physical function (Timed Up‐and‐Go; TUG), and disability (World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0). Qualitative data were collected via semistructured interviews. Results: Higher steps/d was moderately correlated with better TUG time (r = −.58, P <.01), but was not correlated with WHODAS 2.0 score (r = −0.18; P >.10). Qualitative analysis of interviews, using an inductive, team‐based, phenomenological approach, identified four themes: (1) perceptions of their prosthesis, (2) fear during mobility, (3) influence of LLA on life activities, and (4) positive outlook within social interactions. Mixed‐methods analysis used an iterative approach to interpret and describe how psychosocial factors influence physical activity in four exemplar cases. Conclusions: Physical activity in people with dysvascular LLA results from an interaction among perceptions of their prosthesis, fear during mobility, influence of LLA on life activities, and positive outlook within social interactions. The overlapping nature of these themes suggests that interventions targeting psychosocial factors may be associated with improved physical activity, physical function, and subsequent disability after dysvascular LLA. [ABSTRACT FROM AUTHOR]

Background: Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower‐limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. Objective: To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. Design: Cross‐sectional study. Setting: General community. Participants: Participants with LLA (N = 122) were included in this cross‐sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Interventions: Not applicable. Main Outcome Measures: Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self‐efficacy, social support, and motivation, measured using the Self‐Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self‐efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. Results: The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P =.10), with self‐efficacy (P <.001) and social support (P =.002) variables remaining in the final model. The final model fit was statistically improved (P <.001) and explained an additional 6.1% of disability variability when compared to the covariate model. Conclusions: Greater self‐efficacy and social support are related to lower disability after LLA. Findings suggest there may be a role for interventions targeting increased physical function, self‐efficacy, and social support for ambulatory prosthesis users after LLA in middle age or later, especially when complicated by multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Family‐centred care (FCC) is an approach to paediatric rehabilitation service delivery endorsing shared decision making and effective communication with families. There is great need to understand how early intervention (EI) programmes implement these processes, how EI caregivers perceive them, and how they relate to EI service use. Therefore, the purpose of this study is to examine (a) parent and provider perceptions about EI FCC processes and (b) the association between FCC perceptions and EI service intensity. Methods: In this cross‐sectional study, parent perceptions of EI FCC were measured using the electronically administered Measures of Processes of Care (MPOC‐56 and MPOC‐SP; using 7‐point scales). Participants included EI parents (n = 29) and providers (n = 9) from one urban EI programme (1/1/18–6/1/18). We linked survey responses with child characteristics and service use ascertained through EI records. We estimated parent–provider MPOC score correlations and the association between EI service intensity (hr/month) and parent MPOC scores using adjusted linear regression accounting for child characteristics. Results: Parents (M = 4.2, SD = 1.1) and providers (M = 5.8, SD = 1.3) reported low involvement related to general information exchange. Parent and provider subscale scores were not correlated except that parent‐reported receipt of specific information was inversely associated with provider‐reported provision of general information (r = −0.4, P <.05). In adjusted models, parent perceptions related to respectful and supportive (b = 1.57, SE = 0.56) and enabling (b = 1.42, SE = 0.67) care were positively associated with EI intensity, whereas specific information exchange and general information exchange were not associated with intensity. Conclusion: We found that EI parents and providers reported high levels of investment in the family centredness of their EI care, with the exception of information sharing. Greater EI service intensity was associated with higher perception of involvement with some metrics of family centredness. [ABSTRACT FROM AUTHOR]

Background Parkinson disease (PD) may lead to functional limitations through both motor and nonmotor symptoms. Although patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. Objective The objective of the current study was to identify motor, cognitive, and gait determinants of physical functional performance in patients with early to mid-stage PD. Design This was a secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. Setting The study was performed at a tertiary academic medical center. Participants The study included 121 patients with early to mid-stage PD. Methods Our functional performance outcomes included the following: the Continuous Scale Physical Functional Performance Test (CS-PFP; primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance, and gait. Stepwise linear regression models were used to determine correlations between explanatory variables and outcome measures. Results In our regression models, the CS-PFP significantly correlated with walking endurance (Six-Minute Walk Test; r 2 = 0.12, P < .0001), turning ability (360° Turn Test; r 2 = 0.03, P = .002), attention (Brief Test of Attention; r 2 = 0.01, P = .03), overall cognitive status (Mini–Mental State Examination; r 2 = 0.01, P = .04), and bradykinesia (timed tapping; r 2 = 0.02, P = .02). The TUG significantly correlated with walking speed (5-Meter Walk Test; r 2 = 0.33, P < .0001), stride length (r 2 = 0.25, P < .0001), turning ability (360° turn, r 2 = 0.05, P = .0003), and attention (r 2 = 0.016, P = .03). Section 2 of the UPDRS was significantly correlated with endurance (r 2 = 0.09, P < .0001), turning ability (r 2 = 0.03, P = .001), and attention (r 2 = 0.01, P = .03). Conclusions Gait, motor, and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and nonmotor symptoms. [ABSTRACT FROM AUTHOR]

Objective: To characterize patient outcomes after total knee arthroplasty (TKA) by (1) examining changes in self-report measures (Knee Injury and Osteoarthritis Outcome Score [KOOS]) and performance measures over the first 6 months after TKA, (2) evaluating correlations between changes in KOOS self-report function (activities of daily living [ADL] subscale) and functional performance (6-minute walk [6MW]), and (3) exploring how changes in pain correlate with KOOS ADL and 6MW outcomes. Design: Retrospective cohort evaluation. Setting: Clinical research laboratory. Patients (or Participants): Thirty-nine patients scheduled for a unilateral, primary TKA for end-stage unilateral knee osteoarthritis. Methods: Patients were evaluated 2 weeks before surgery and 1, 3, and 6 months after surgery. Main Outcome Measurements: KOOS, 6MW, timed-up-and-go (TUG), and stair climbing tests (SCT), quadriceps strength. Results: Three of 5 KOOS subscales significantly improved by 1 month after TKA. All 5 KOOS subscales significantly improved by 3 and 6 months after TKA. In contrast, performance measures (6MW, TUG, SCT, and quadriceps strength) all significantly declined from preoperative values by 1 month after TKA and significantly improved from preoperative values by 3 and 6 months after TKA; yet, improvements from preoperative values were not clinically meaningful. Pearson correlations between changes in the KOOS ADL subscale and 6MW from before surgery were not statistically significant at 1, 3, or 6 months after TKA. In addition, KOOS Pain was strongly correlated with KOOS ADL scores at all times, but KOOS Pain was not correlated with 6MW distance at any time. Conclusions: Patient self-report by using the KOOS did not reflect the magnitude of performance deficits present after surgery, especially 1 month after TKA. Self-report KOOS outcomes closely paralleled pain relief after surgery, whereas performance measures were not correlated with pain. These results emphasize the importance of including performance measures when tracking recovery after TKA as opposed to solely relying on self-reported measures. [Copyright &y& Elsevier]

Gait dysfunction is an early problem identified by patients with Parkinson's disease (PD). Alterations in gait may result in an increase in the energy cost of walking (i.e., walking economy). The purpose of this study was to determine whether walking economy is atypical in patients with PD when compared with healthy controls. A secondary purpose was to evaluate the associations of age, sex, and level of disease severity with walking economy in patients with PD. The rate of oxygen consumption (V̇O2) and other responses to treadmill walking were compared in 90 patients (64.4 ± 10.3 years) and 44 controls (64.6 ± 7.3 years) at several walking speeds. Pearson correlation coefficients (r) were calculated to determine relationships of age, sex, and disease state with walking economy in PD patients. Walking economy was significantly worse in PD patients than in controls at all speeds above 1.0 mph. Across all speeds, V̇O2 was 6 to 10% higher in PD patients. Heart rate, minute ventilation, respiratory exchange ratio, and rating of perceived exertion were correspondingly elevated. No significant relationship of age, sex, or UPDRS score with V̇O2 was found for patients with PD. The findings suggest that the physiologic stress of daily physical activities is increased in patients with early to mid-stage PD, and this may contribute to the elevated level of fatigue that is characteristic of PD. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Objective: Despite considerable effort to reduce low back pain (LBP), approximately 60% of patients have recurrence after their first episode. The high rate of recurrence suggests that more effective intervention approaches are needed. This randomized, controlled feasibility trial was designed to compare disability, physical functional capacity, and pain outcomes at 2, 6, and 12 months for 2 conventional and 1 novel physical therapy (functional movement training) intervention for recurrent LBP. Design: Randomized, controlled feasibility trial. Setting: University hospital outpatient physical therapy clinic. Participants: Sixty-one participants (60% female) with recurrent LBP. Interventions: Subjects were randomized to 1 of 3 intervention groups: group 1 had a single session consisting of standard back pain education; group 2 had 6 sessions in 8 weeks of conventional physical therapy; and group 3 had 6 sessions in 8 weeks of a novel method of functional movement training. Change from baseline was used to determine within-group changes and between-group differences for participants who finished each time point (2, 6, and 12 months). Changes were evaluated using analysis of variance and Newman-Keuls post hoc analysis. Main Outcome Measures: The primary outcome measure was the novel Continuous Scale Physical Functional Performance test (CS-PFP), a measure of actual physical functional capacity. Secondary measures included the revised Oswestry Disability Index, a measure of pain-related disability, the Roland Morris Disability Questionnaire, and a standard visual analogue pain scale. Results: Of the participants, 67% provided data at 2 months and 44% provided information at 12 months. Raw change scores were evaluated at 2, 6, and 12 months. While no statistical significance was reached with any outcome measure, the trends suggested little change for group 1 (education) and suggested that greatest improvement in function may occur in group 3 (functional movement training). In particular, at 2 months, the CS-PFP change scores revealed a trend (P=.072) toward greater improvement in groups 2 (conventional physical therapy) and 3 (functional movement training) compared with group 1. At 12 months, Oswestry Disability Index and CS-PFP scores also trended toward significance for groups 2 and 3 (P=.7 and .9, respectively). Mean change scores were also calculated and revealed groups 2 and 3 had improved by 2 months and this improvement remained stable at the 1-year mark. Trends in the direction of best improvement occurred for those in the functional movement training group. Conclusion: A large-scale randomized, controlled trial is warranted to determine whether an intervention based on functional movement training is superior to conventional, impairment-based intervention for individuals with recurrent LBP. [Copyright &y& Elsevier]

The article presents a study on the relative contributions of adiposity and muscularity to multi-dimensional performance-based and perceived physical function in older adults living independently. The study observed 109 women and men, aged 60 or older, with low serum dehydroepiandrosterone sulfate levels. It concluded that adiposity was a strong predictor of measured and self-reported physical function than was muscularity in older adults living independently.

OBJECTIVES: To determine the patterns of wheelchair use in terms of locations of use, whether wheelchair use in one location was related to wheelchair use in other locations, and factors associated with wheelchair use in different locations. DESIGN: Longitudinal cohort study. SETTING: Patients prescribed wheelchairs by clinicians at one of two teaching hospitals (one Veterans Affairs hospital and one private hospital). PARTICIPANTS: One hundred fifty-three consecutive persons who were prescribed a new wheelchair, resided in the community, had a Short Portable Mental Status Questionnaire score of greater than six out of 10, and who could be interviewed within 7 to 21 days of receiving the wheelchair. MEASUREMENTS: Patient, wheelchair, and environmental characteristics and self-reported wheelchair use in life spaces. RESULTS: Wheelchair use in the 24 hours before the interview was inconsistent across life spaces. The correlation between wheelchair use in the bath and in the kitchen was 0.66, between locations near and far from home was -0.08, and between locations in the home and outside the home was 0.08. Predictors of wheelchair use in the home were using help from another person to propel the wheelchair (odds ratio (OR) = 0.14, 95% confidence interval (CI) = 0.04–0.45), the number of impairments (OR = 0.80, 95% CI = 0.67–0.96), a report that the wheelchair did not meet the subject's needs (OR = 3.71, 95% CI = 1.27–10.81), and having adapted the home to accommodate the wheelchair (OR = 3.75, 95% CI = 1.47–8.18). Having adapted the home was also positively associated with use of the wheelchair in areas near the home (OR = 4.77, 95% CI = 1.94–11.71). The only factor associated with wheelchair use in distant locations was older age (OR = 0.62, 95% CI = 0.46–0.83 per 10-year increment). CONCLUSIONS: Personal factors (e.g., using help to propel the wheelchair) and environmental factors (e.g., home adaptations to accommodate... [ABSTRACT FROM AUTHOR]