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BACKGROUND: Balance-based torso-weighting has improved gait and balance performance in people with multiple sclerosis (MS) in a single session with torso-weights on, demonstrating an orthotic effect. Daily use of torso-weighting may promote motor learning and more enduring therapeutic effects but has not yet been studied. PURPOSE: Confirm orthotic effects and compare therapeutic effects of daily torso-weighting versus shape/sham-weighting or no weighting. We hypothesized that daily torso-weighting would result in positive effects on gait and balance, tested without weights. METHODS: Five participants with MS experienced three conditions for 2-4 weeks each: no weights first, then double-blinded randomization to torso-weighting or shape-weighting first then cross-over to the alternate condition. Personalized torso-weighting on a vest-like garment countered individual reactive balance responses following manual perturbations. Postural sway recorded orthotic effects with/without torso-weights while standing on a force plate with eyes open/closed. Clinical measures recorded therapeutic effects while unweighted: gait parameters, 6-Minute Walk Test (6MWT), and Sensory Organization Test (SOT). Weighting conditions were compared using paired t-tests with one-tailed alpha at 0.05. RESULTS: Postural sway decreased significantly with torso-weights. Cadence and step width improved significantly after torso-weighting versus shape-weight periods. Average gait parameters showed no improvement after shape-weight periods. Velocity, 6MWT, and SOT tended to improve with torso-weighting, averaging improvements of+15%,+16%, and+13.8%, respectively. CONCLUSIONS: Findings support both orthotic and therapeutic effects of torso-weighting. Daily use of torso-weights for multiple weeks may promote motor learning of gait parameters and balance. Further research is warranted to examine sensory augmentation as a potential mechanism.

BACKGROUND: Multiple sclerosis (MS) and Parkinson’s disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations. OBJECTIVE: 1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions. METHODS: 1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6–10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence. RESULTS: 1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p

Measurement choices play a critical role in improving healthcare systems. As this book describes, improved measurement can promote excellence in person-centered outcomes through health policy, methodology, theory, and clinical practice. This chapter focuses on measurement choices within clinical practice that can guide decision-making for improved outcomes. The overall objective is for clinical practice to deliver high-quality and equitable healthcare tailored to the unique situation of each specific person. Separate sections discuss the context surrounding measurement choices, specific dilemmas or competing priorities that affect measurement choices, and recommendations for improving person-centered outcome measurement.

Background: Individuals with multiple sclerosis (MS) frequently report sexual dysfunction, a condition that may result in low sexual satisfaction and decreased quality of life. Although sexual dysfunction is usually treated pharmacologically, physical therapists, especially those trained in pelvic floor physical therapy (PT), are well-equipped to address a variety of impairments that contribute to poor sexual function. The current evidence for effectiveness of PT interventions in improving sexual dysfunction, sexual satisfaction, and the emotional well-being aspect of quality of life was analyzed. Methods: The PubMed, CINAHL, and PEDro databases were searched through December 2019. Articles were included if participants had a clinical diagnosis of MS, reported sexual dysfunction or pain with intercourse, and had an intervention within the PT scope that addressed sexual dysfunction. Means and SDs were extracted from each study independently by two authors. Effect sizes (d) and 95% CIs were calculated within and across studies. Results: Eight studies met the inclusion criteria. Combined effects were significant and large across six studies for sexual function (d = 0.82, 95% CI, 0.57–1.06), moderate across seven studies for sexual satisfaction (d = 0.65, 95% CI, 0.43–0.87), and moderately large across two studies for emotional well-being (d = 0.78, 95% CI, 0.17–1.40). Between-group differences reached significance for sexual satisfaction (d = 0.29, 95% CI, 0.03–0.55). Conclusions: Sexual function, sexual satisfaction, and emotional well-being can all be effectively addressed with various PT interventions. Highly effective interventions included pelvic floor muscle training and mindfulness. Future research should compare PT interventions with non-PT controls to determine best practice in this population.

Homeless adults may experience accelerated aging, presenting earlier with geriatric syndromes such as falls and functional limitations. Though homelessness is surging in United States, data are scarce regarding rates of physical dysfunctions characteristic of geriatric syndromes experienced in this underserved population.Examine associations between homelessness, premature geriatric syndromes, and functional limitations.Two reviewers independently searched PubMed, CINAHL, and PEDro databases for prognostic studies reporting rates of geriatric syndromes in homeless adults aged 40 years and older. Two reviewers independently performed study selection. Data were extracted for homeless adults and community-dwelling controls regarding age, demographic information, limitations of activities of daily living (ADL) and instrumental ADL (IADL), frailty, and falls the past year. Risk ratio (RR) and 95% confidence interval (CI) were calculated across studies to compare groups.Five studies met predetermined criteria. Meta-analysis revealed greater rates in homeless adults (average age 56) compared to housed adults (average age 78) for ADL limitation (RR = 1.50, 95% CI = 1.37-1.64) and IADL limitation (RR = 1.36, 95% CI = 1.28-1.45). Falls were three times more prevalent in homeless individuals (RR = 3.42, 95% CI = 3.16-3.70). Heterogeneous frailty data did not reach significance (RR = 2.59, 95% CI = 0.90-7.46).Homeless adults have increased risk of premature geriatric syndromes. Limitations in ADL and IADL rates were 30-50% higher than adults with stable housing averaging 20 years older, and fall rates were three times higher than controls averaging 4.5 years older. These results underscore the need for healthcare providers such as physical therapists to address physical dysfunction in homeless adults.

The advancement of college reading abilities from novice to expert is not an automatic outcome of an undergraduate education. Faculty play a large role in the undergraduate academic reading experie...

Objective Direct access to physical therapy provides an alternative to physician-first systems for patients who need physical therapy for musculoskeletal disorders (MSDs). Direct access across multiple countries and the United States (US) military services has produced improved functional outcomes and/or cost-effectiveness at clinical and health care system levels; however, data remain scarce from civilian health care systems within the United States. The purpose of this study was to compare evidence regarding costs and clinical outcomes between direct access and physician-first systems in US civilian health services. Methods A database search of PubMed, CINAHL, Cochrane Reviews, and PEDro was conducted through May 2019. Studies were selected if they specified civilian US, physical therapy for MSDs, direct access or physician-first, and extractable outcomes for cost, function, or number of physical therapy visits. Studies were excluded if interventions utilized early or delayed physical therapy access compared with physician-first. Five retrospective studies met the criteria. Means and standard deviations for functional outcomes, cost, and number of visits were extracted, converted to effect sizes (d) and 95% CI, and combined into grand effect sizes using fixed-effect or random-effects models depending on significance of the Q heterogeneity statistic. Results Direct access to physical therapy showed reduced physical therapy costs (d = −0.23; 95% CI = −0.35 to −0.11), total health care costs (d = −0.19; 95% CI = −0.32 to −0.07), and number of physical therapy visits (d = −0.17; 95% CI = −0.29 to −0.05) compared to physician-first systems. Disability decreased in both direct access (d = −1.78; 95% CI = −2.28 to −1.29) and physician-first (d = −0.89; 95% CI = −0.92 to −0.85) groups; functional outcome improved significantly more with direct access (z score = 0.89; 95% CI = 0.40 to 1.39). Conclusions Direct access to physical therapy is more cost-effective, resulting in fewer visits than physician-first access in the United States, with greater functional improvement. Impact These findings within civilian US health care services support a cost-effective health care access alternative for spine-related MSDs and can inform health care policy makers.

This cross-sectional study at a four-year college explored the alignment between students’ and faculty perceptions and behaviors regarding academic reading. Constructs from the academic reading lit...

Objectives People with cerebellar ataxia have few options to improve the standing stability they need for function. Strategic placement of light weights on the torso using the balance‐based torso‐weighting (BBTW) method has improved stability and reduced falls in people with multiple sclerosis, but has not been tested in cerebellar ataxia. We examined whether torso‐weighting increased standing stability and/or functional movement in people with cerebellar ataxia. Methods Ten people with cerebellar ataxia and 10 matched controls participated in this single‐session quasi‐experimental pilot study. People with ataxia performed the Scale for the Assessment and Rating of Ataxia (SARA) prior to clinical testing. All participants donned inertial sensors that recorded postural sway; stopwatches recorded duration for standing and mobility tasks. All participants stood for up to 30 s on firm and foam surfaces with eyes open then eyes closed, and performed the Timed Up and Go (TUG) test. Light weights (0.57–1.25 kg) were strategically applied to a vest‐like garment. Paired t tests compared within‐group differences with and without BBTW weights. Independent t tests assessed differences from controls. All t tests were one‐tailed with alpha set at .05. Results Duration of standing for people with ataxia was significantly longer with weighting (p = .004); all controls stood for the maximum time of 120 s with and without weights. More severe ataxia according to SARA was moderately correlated with greater improvement in standing duration with BBTW (Pearson r = .54). Tasks with more sensory challenges (eyes closed, standing on firm surface) showed less body sway with weighting. Duration for the TUG was unchanged by torso‐weighting in people with ataxia. Conclusion Strategic weighting improved standing stability but not movement speed in people with ataxia. BBTW has potential for improving stability and response to challenging sensory conditions in this population. Future studies should further examine gait stability measures along with movement speed.

Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk ≥2-min were prospectively recruited. At 4weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC=0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p&nbsp

Purpose: The purpose of this systematic review and meta-analysis was to synthesize the current literature on the effects of bone-loading exercise on bone mineral density (BMD) in women after treatment of breast cancer (BC). Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Web of Science databases were searched through March 31, 2016. A combination of MeSH terms and key words was used: (physical therapy OR physiotherapy OR resistance training OR weight training OR aerobic OR exercise) AND (bone density OR osteoporosis) AND breast cancer. Search terms for PEDro were as follows: (breast cancer AND bone breast cancer) and (breast cancer AND osteoporosis). Studies included were experimental studies that compared any type of bone-loading exercise intervention with a comparison group and reported dual-energy x-ray absorptiometry for assessment of BMD of the lumbar spine and/or proximal femur (femoral neck, trochanter, and/or total hip). Between-group BMD effect sizes and 95% confidence intervals (CIs) were calculated for each study (bone-loading exercise vs usual care/non–bone-loading exercise) and pooled across studies. Risk of bias in and across studies was addressed using the PEDro scale. Results: Five randomized controlled studies were included. Pooled effect sizes were statistically significant, favoring the bone-loading exercise group for proximal femur (d = 0.15; 95% CI, 0.03-0.28) and for lumbar spine BMD (d = 0.14; 95% CI, 0.01-0.27). Conclusion: Results provide modest evidence that bone-loading exercise interventions have statistically and clinically significant effects on proximal femur and lumbar spine BMD in women treated for BC. Further research is warranted to determine the most effective types and intensities of exercise for improving BMD in BC survivors.

Academic reading proficiently is characterized by the ability to perform cognitive tasks associated with interpreting text. Researchers developed an externally validated Informal Academic Reading Proficiency Test to gauge undergraduates’ academic reading proficiency. A cross-sectional study of 23 classes completed the reading test in 2014. This convenience sample totaled 848 undergraduates. Academic reading proficiency did not vary significantly by class level. Students who earned high school diplomas in the United States had greater academic reading proficiency than students who did not earn their diplomas in the United States. The results of a cross-sectional, undergraduate academic reading proficiency test of 848 students reveal that students do not necessarily improve their reading as they progress toward college graduation and that many struggle with a common set of reading tasks across all class levels.

Background: In people with multiple sclerosis (MS), common gait and balance impairments can lead to falls, fear of falling, activity restriction, and social isolation. Sensory augmentation in the form of torso-weighting has resulted in improvement in gait and balance, but research on its effect on falls in MS is lacking. Methods: 60 people with MS and 10 bin-matched controls completed the Sensory Organization Test (SOT) while nonweighted and again while weighted using the Balance-Based Torso-Weighting assessment method. This was a quasi-experimental pre-post intervention study. The SOT composite scores, equilibrium scores, and number of falls occurring across six SOT conditions were compared between and within groups using 2-way analysis of variance, α = .05 with planned t test analyses of weighting effects. Results: A significant increase in composite score of 9.14 points nonweighted to weighted occurred in the MS group (P < .001) but not in controls (P = .626). Equilibrium scores were significantly higher with weights in the MS group (P < .001) but not in controls (P = .5). Falls during the SOT were reduced by 35% with weights in the MS group versus without weights (P < .001), with the greatest number of falls occurring in the most challenging SOT conditions. Conclusions: During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the SOT for people with MS but no change in controls. Further research is needed to determine whether torso-weighting has the potential to reduce falls in MS during real-world activities.

Background: Multiple sclerosis (MS) presents with many debilitating symptoms, including urinary incontinence (UI), that physical therapy (PT) may address; UI is widely prevalent, but PT management of symptoms lacks consensus. A meta-analysis of long-term nonsurgical and nonpharmaceutical treatment options may supply this deficiency. We analyzed the current evidence for effectiveness of PT to decrease UI and improve quality of life (QOL) in people with MS. Methods: An electronic search conducted through November 26, 2013, included the following search terms: incontinence, bladder dysfunction, urinary incontinence, multiple sclerosis, MS, physical therapy, physiotherapy, therapy, and rehabilitation. Criteria for inclusion were as follows: MS diagnosis, intervention involved PT for UI or bladder dysfunction, outcomes assessed QOL or UI, and at least a 4 of 10 on the Physiotherapy Evidence Database scale or a 2b level of evidence. Outcomes were combined across studies, and effect sizes are depicted in forest plots. Results: Six studies met the inclusion criteria. Between-group analysis revealed statistically significant differences in incontinence episodes and QOL, but did not reach significance for functional control mechanisms (eg, electromyography data on strength of contraction, relaxation, and endurance). Incontinence leakage episodes and QOL participation improved within groups. Conclusions: Meta-analysis indicates support for PT for minimizing incontinence compared with pretreatment and affecting incontinence and QOL more than control in people with MS. Protocols were heterogeneous regarding duration and type of PT intervention and were applied in different types of MS. Further research may reveal the most effective combination and variety of PT interventions for people with MS.

Despite the well-known benefits of using standardized outcome measures (OMs) in clinical practice, a variety of barriers interfere with their use. In particular, rehabilitation therapists lack sufficient knowledge in selecting appropriate OMs. The challenge is compounded when working with people with multiple sclerosis (MS) owing to heterogeneity of the patient population and symptom variability in individual patients. To help overcome these barriers, the American Physical Therapy Association appointed the Multiple Sclerosis Outcome Measures Task Force to review and make evidence-based recommendations for OM use in clinical practice, education, and research specific to people with MS. Sixty-three OMs were reviewed based on their clinical utility, psychometric properties, and a consensus evaluation of the appropriateness of use for people with MS. We sought to illustrate use of the recommendations for two cases. The first case involves a 43-year-old man with new-onset problems after an exacerbation. The second case pertains to an outpatient clinic interested in assessing the effectiveness of their MS rehabilitation program. For each case, clinicians identified areas that were important to assess and various factors deemed important for OM selection. Criteria were established and used to assist in OM selection. In both cases, the described processes narrowed the selection of OMs and assisted with choosing the most appropriate ones. The recommendations, in addition to the processes described in these two cases, can be used by clinicians in any setting working with patients with MS across the disability spectrum.

Background and Purpose People with multiple sclerosis (PwMS) commonly have mobility impairments that may lead to falls and limitations in activities. Physiotherapy interventions that might improve mobility typically take several weeks. Balance-based torso-weighting (BBTW), a system of strategically placing light weights to improve response to balance perturbations, has resulted in immediate small improvements in clinical measures in PwMS, but changes in spatio-temporal gait parameters are unknown. The purpose was to investigate the effects of BBTW on gait parameters in PwMS and healthy controls.

Various studies have described the benefits of using outcome measures (OMs) in physical therapist practice1–3; however, multiple barriers interfere with their use (eTab. 1).1,3,4 Most notably, a limited understanding of how to select and apply the best OM has been reported to be a barrier.3,4 Wedge et al3 reported that physical therapists do not always critically evaluate the psychometric properties of OMs, are unfamiliar with OM-related resources, and have difficulties determining patient suitability for particular OMs. Physical therapists working with people with multiple sclerosis (MS) have additional challenges when selecting OMs. Multiple sclerosis is a complex, heterogeneous, and progressive disorder causing a wide variety of symptoms among patients.5,6 Symptom variability in individual patients throughout the course of the disease also must be considered. Additionally, people with MS are treated in a variety of settings, which may affect OM selection and use (eg, due to limited space and equipment in a home environment). Thus, selecting 1 or 2 OMs for use with all people with MS is challenging, requiring the clinician to determine the most appropriate OMs to measure relevant constructs. Although some resources exist to assist the physical therapist with identifying and selecting OMs for people with MS,7–13 literature is lacking that describes a consensus-based method to determine which OMs are appropriate for people with MS at various disability levels and in different practice settings. In 2009, the American Physical Therapy Association (APTA) Neurology Section (“the Section”) began a process to develop recommendations for the use of OMs for patients with neurological conditions, beginning with stroke (information pertaining to the Section's OM recommendations is available elsewhere14). The following year, the Section expanded its efforts by creating a task force …

Importance Disability measures in multiple sclerosis (MS) fail to capture potentially important variability in walking behavior. More sensitive and ecologically valid outcome measures are needed to advance MS research. Objectives To assess continuous step count activity remotely among individuals with MS for 1 year and determine how average daily step count is associated with other measures of MS disability. Design, Setting, and Participants In a prospective longitudinal observational cohort study, 95 adults with relapsing or progressive MS who were able to walk more than 2 minutes with or without an assistive device were recruited between June 15, 2015, and August 8, 2016, and remotely monitored in their natural environment for 1 year. Patients were excluded if they had a clinical relapse within 30 days or comorbidity contributing to ambulatory impairment. Longitudinal analysis was performed from October 2017 to March 2018. Revised analysis was performed in December 2018. Intervention Activity monitoring of step count using a wrist-worn accelerometer. Main Outcomes and Measures Average daily step count compared with in-clinic assessments and patient-reported outcomes. Results Of the 95 participants recruited (59 women and 36 men; mean [SD] age, 49.6 [13.6] years [range, 22.0-74.0 years]), 35 (37%) had progressive MS, and the median baseline Expanded Disability Status Scale score was 4.0 (range, 0-6.5). At 1 year, 79 participants completed follow-up (83% retention). There was a modest reduction in accelerometer use during the 1 year of the study. A decreasing average daily step count during the study was associated with worsening of clinic-based outcomes (Timed 25-Foot Walk, β = −13.09; P, This longitudinal cohort study assesses how remote monitoring of continuous step count activity for 1 year among individuals with multiple sclerosis is associated with other measures of multiple sclerosis disability., Key Points Question Is remote monitoring of continuous activity for 1 year among individuals with multiple sclerosis associated with other measures of ambulatory disability? Findings In this longitudinal cohort study, 95 individuals with multiple sclerosis were asked to wear accelerometers for 1 year; at baseline, a low step count was associated with increased risk of clinical worsening at 1 year. Step count reduction during the study was associated with worsening of clinic-based and patient-reported outcomes and occurred even when conventional disability measures remained stable. Meaning Remote step count monitoring might represent a sensitive longitudinal outcome measure with direct implications for multiple sclerosis clinical trials and care.

Background If disability is the gap between what an individual can do and what that individual would like to be able to do, then measures that assess only current ability fall short of describing the impact of disability on the individual. Objective The aim of this study was to examine a potential measure of disability, the gap between current movement ability and preferred movement ability, as recorded with the Movement Ability Measure (MAM). This investigation was performed by establishing the relationship between self-perceived current ability and other measures and examining the evidence of convergence or divergence between the gap and other measures. Design This investigation was a descriptive study. Methods Thirty people who had multiple sclerosis and were ambulatory completed the MAM and 18 other measures of bodily function, activity, and participation. Item response theory methods were used to generate logit estimates of average current movement ability and separate abilities in the 6 dimensions of movement on the MAM. Pearson correlations were calculated between estimated abilities from the MAM and scores from measures expected to be associated with these estimated abilities, as well as between the MAM and additional measures in exploratory analyses of relationships. Results The average current ability and the separate dimensions correlated moderately to strongly (.5–.8) with many of the measures expected to be related and showed additional moderately strong correlations in exploratory analyses. The average gap between current ability and preferred ability correlated moderately with pain (−.56) and a scale of current ability (.46) but diverged from many of the measures. Limitations The limitations of this study included the lack of an intervention to assess the response of the gap to therapy and the use of multiple statistical tests with a small sample. Conclusions The evidence supports the convergent validity for current ability on the MAM but mostly the divergence of the gap. Additional research should compare the gap specifically with measures that assess patients' preferences when determining disability.

Objective. To develop and validate a shortened version of the Valued Life Activities disability and accommodations scale (VLA) for individuals with rheumatoid arthritis (RA). Methods. To shorten the existing VLA measure, item response theory analyses were conducted using data from 449 patients with RA. Next, the resulting 14-item shortened version of the VLA scale (S-VLA) was evaluated by structured interviews among 20 RA patients. Lastly, the S-VLA was administered to 150 RA patients along with other measures, including the Health Assessment Questionnaire (HAQ) and Short Form 36 (SF-36). A random sample of 50 patients completed the S-VLA 2 weeks later to assess reliability. Item statistics were calculated to evaluate correlations between individual items and the S-VLA total score. Correlations between the S-VLA and other measures were used to evaluate validity. Results. Test–retest reliability was 0.91, while Cronbach’s alpha for the S-VLA was 0.95. None of the 14 items was associated with improved alpha coefficients when omitted. All of the items were strongly correlated with the S-VLA total score. S-VLA scores were highly positively correlated with the HAQ (r 0.81, P < 0.001), patient-reported disease activity (r 0.71, P < 0.001), satisfaction with abilities (r 0.82, P < 0.001), and number of days with activity limitations (r 0.65, P < 0.001). In addition, as hypothesized, the S-VLA was inversely correlated with the SF-36 physical component summary score (r 0.78, P < 0.001) and the physical functioning (r 0.80, P < 0.001), role physical (r 0.67, P < 0.001), and social functioning (r 0.72, P < 0.001) subscales. Conclusion. The S-VLA is a short, valid, and reliable instrument that may prove useful for monitoring disability among individuals with RA.

Examine the theoretical construct of a gap between people's perceived current and preferred movement abilities and its potential for evaluating rehabilitation outcomes against clients' desired goals.A cross-section of 311 community-dwelling adults completed a 24-item movement ability measure (MAM) and a visual analog movement scale. In a nonrandomized pre-post design, two subsets of that population completed the measures again after 2 weeks: 35 clients undergoing outpatient physical therapy and 34 in a comparison group who were not undergoing physical therapy. Scores on the MAM were analyzed using item response theory methods.The gap between current and preferred ability in the 311 adults represented one level difference on average out of six designated movement levels on both measures. Clients about to undergo physical therapy had gaps approximately twice the size of gaps in the 34-person comparison group on both measures (P0.001). Both the MAM and the movement scale showed a significantly narrower gap after 2 weeks for the group in physical therapy (P0.001) but no change for the comparison group.Assessing gaps between client-perceived current and preferred movement ability following intervention may help in the evaluation of rehabilitation outcomes from the client's perspective.

Purpose. To examine the construct validity of the International Classification of Functioning Disability and Health (ICF) framework using multidimensional item response modelling and data collected in different regions from patients with five chronic health conditions. We assume that the ICF components should represent statistically called dimensions that are distinct although related. Method. Retrospective validation study using the ICF Core Sets from a convenience sample of patients in an international multicentre, cross-sectional database obtained in different rehabilitation centres. Health professionals working in 89 rehabilitation centres in 32 countries collected data from 3227 rehabilitation patients using the respective ICF Core Sets. Patients included had one of the following health conditions: low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), obesity (OB) or post-stroke. Data from questions regarding a patient’s functioning based on body structures and functions, activities, participation along the ICF Core Sets were analysed with multidimensional item response modelling. Results. The multidimensional models fit the data better than a model with few or no specifications regarding an underlying framework. For example, a model separating four dimensions ‘body structures’, ‘body functions’, ‘activities’ and ‘participation’ fits the data better than a model differentiating between ‘body functions and structures’ and ‘activities and participation’. The ICF framework with its components represents underlying statistically called dimensions. Conclusion. The results of this study support the construct validity of the functioning part of the ICF. The distinct dimensions may facilitate the alignment of ICF components with other measures used clinically and in research. Based on our results it is justifiable to construct instruments integrating ICF categories within components.

Background. Torso weighting has sometimes been effective for improving upright mobility in people with multiple sclerosis, but parameters for weighting have been inconsistent. Objective. To determine whether balance-based torso weighting (BBTW) has immediate effects on upright mobility in people with multiple sclerosis. Methods. This was a 2-phase randomized clinical trial. In phase 1, 36 participants were randomly assigned to experimental and control groups. In phase 2, the control group was subsequently randomized into 2 groups with alternate weight-placement. Tests of upright mobility included: timed up and go (TUG), sharpened Romberg, 360-degree turns, 25-foot walk, and computerized platform posturography. Participants were tested at baseline and again with weights placed according to group membership. In both phases, a physical therapist assessed balance for the BBTW group and then placed weights to decrease balance loss. In phase 1, the control group had no weights placed. In phase 2, the alternate treatment group received standard weight placement of 1.5% body weight. Results. People with BBTW showed a significant improvement in the 25-foot walk ( P = .01) over those with no weight, and the TUG ( P = .01) over those with standard weight placement. BBTW participants received an average of 0.5 kg, less than 1.5% of any participant’s body weight. Conclusion. BBTW can have immediate advantages over a nonweighted condition for gait velocity and over a standardized weighted condition for a functional activity in people with multiple sclerosis (MS) who are ambulatory but have balance and mobility abnormalities.

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence. Objective To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS). Design Quasi-experimental study in which subjects served as their own controls. Setting Research laboratory. Participants Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society. Interventions Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions. Main Outcome Measures Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk. Results Significant improvement ( P P Conclusions Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.

Retrospective descriptive analysis. The purpose of this study was to report the functional ability of children with spinal cord injury (SCI) as recorded on motor items of the functional independence measure (FIM) and to examine the factors associated with FIM motor admission and post-discharge gain scores. Scores on FIM motor items were analyzed from 941 children (age range: 0–21 years; mean: 13 years 4 months; s.d.: 4 years 8 months) admitted in acute-to-chronic time periods post-SCI to Shriners Hospitals for Children (USA). FIM motor scores at admission and gains at discharge were examined along with neurological level, completeness of injury, age, etiology of injury, and length of time between injury and admission and admission and discharge. The FIM motor scores at admission were negatively correlated with age, neurological level and completeness of injury. Gain in FIM motor scores was significant across neurological levels, and was associated with lower admission FIM motor scores, lower neurological level, incomplete injury, traumatic injury and less time between injury and admission. The motor function of children after pediatric SCI depends on neurological level and completeness of injury, among other factors. FIM motor scores can improve with intervention even several years after the injury.

Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test.Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items.Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains.Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.

Objective To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. Methods Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. Results 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. Conclusions These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.

Background and PurposeDesigned as a self-report assessment, the Movement Ability Measure (MAM) may contribute to effectiveness research if it proves responsive to change. The purpose of this article is to report evidence of responsiveness of the MAM.SubjectsThirty-five adults starting outpatient physical therapy intervention completed the MAM at the initial visit, at 2 weeks, and at 2 months or discharge. Thirty-four no-intervention volunteers completed the MAM twice.MethodsThe MAM responses were analyzed with item response theory methods; t tests were used to compare responses across test occasions.ResultsPaired t tests revealed significant changes in the intervention group at both 2 weeks and 2 months, with an effect size of 0.90 and a responsiveness index of 5.62 at discharge. At 2 weeks and at discharge, 57% and 80% of participants, respectively, showed gains greater than the minimal clinically important difference. Participants in the no-intervention group showed no significant change.Discussion and ConclusionThe MAM responses revealed significant and clinically important changes following intervention. The MAM shows promise as a self-report measure of the effectiveness of physical therapy intervention.

Background and Purpose Physical therapists lack instruments that assess movement across diagnoses and ability levels while focusing on physical therapy–specific outcomes. This article describes the creation of a Movement Ability Measure (MAM) and initial evidence of validity and reliability. Subjects More than 300 adult volunteers with various movement levels completed the 24-item questionnaire. Methods Item response theory methods were used to create the MAM and gather evidence of content and construct validity, test-retest and other types of reliability, and concurrent validity with the California Functional Evaluation instrument and self-acknowledgement of movement problems. Results The intraclass correlation coefficient for test-retest reliability was .92. Person separation reliability was .98. Correlation (r) with the California Functional Evaluation instrument was .76. Respondents who denied having movement problems perceived a significantly higher level of movement ability than those who claimed to have a little, some, or a lot of movement problems in the preceding week. Discussion and Conclusion The MAM shows promise for documenting perceived movement ability across ability levels and diagnoses.

Background and Purpose The Movement Continuum Theory (MCT) provides a potential basis for movement assessment and intervention, but “movement” lacks specificity. The purposes of this study were to propose and evaluate a subdivision of movement into multiple dimensions. Subjects A convenience sample of 318 adults completed a 24-item self-report measure of movement ability. Methods A multimethod approach was used to identify, operationalize, and test a multidimensional model of movement. Data analysis included a comparison of the fit of unidimensional and multidimensional models using item response theory methods and inspection of response patterns. Results A model specifying 6 dimensions—flexibility, strength, accuracy, speed, adaptability, and endurance—fit respondent data significantly better than the unidimensional model, even with high pair-wise correlations between dimensions. Response patterns showed large differences rather than uniform scores across dimensions for over half of the respondents. Discussion and Conclusion Subdividing movement into the proposed dimensions fits the data and potentially strengthens the usefulness of the MCT as a theoretical foundation for managing movement effectively.

This paper is the first of several papers designed to demonstrate how the application of item response models in the behavioral sciences can be used to enhance the conceptual and technical toolkit of researchers and developers and to understand better the psychometric properties of psychosocial measures. The papers all use baseline data from the Behavior Change Consortium data archive. This paper begins with an introduction to item response models, including both dichotomous and polytomous versions. The concepts of respondent and item location, model interpretation, standard errors and testing model fit are introduced and described. A sample analysis based on data from the self-efficacy scale is used to illustrate the concepts and techniques.

When measuring participant-reported attitudes and outcomes in the behavioral sciences, there are many instances when the common measurement assumption of unidimensionality does not hold. In these cases, the application of a multidimensional measurement model is both technically appropriate and potentially advantageous in substance. In this paper, we illustrate the usefulness of a multidimensional approach to measurement using an empirical example taken from the Behavior Change Consortium. Data from the Treatment Self-Regulation Questionnaire have been analyzed to investigate whether self-regulation can be regarded as a single construct, or if it has multiple dimensions based on the type of regulation or motivation that participants say helps them consider an improvement in healthy behavior. Comparison with consecutive analyses shows the advantages of multidimensional measurement for interpreting participant-reported data.

Background & Aims: We sought to determine whether prolyl endopeptidase (PEP) treatment of food gluten would obviate the intestinal dysfunction produced by small amounts of dietary gluten supplement in patients with celiac sprue. Methods: Twenty asymptomatic patients with histologically proven celiac sprue completed a randomized, double-blind, cross-over study involving two 14-day stages. Each patient consumed a low dose of a gluten supplement daily (5 g; equivalent to 1 slice of bread) in 1 stage and gluten pretreated with PEP in the other stage. Patients completed a daily symptom questionnaire and a D-xylose urine excretion and a 72-hour quantitative fecal fat were monitored before and after each stage. Results: Despite clinical remission at baseline, 40% of patients had at least 1 abnormal celiac antibody, 20% had an abnormal urine xylose, and 63% had an abnormal fecal fat test result. There was no difference in symptoms as a function of the type of gluten consumed. In response to gluten not treated with PEP, an appreciable proportion of patients developed malabsorption of fat (7 of 17, 41%) or xylose (8 of 14, 57%). When the gluten was pretreated with PEP, fat malabsorption was avoided in 5 of 7 and xylose malabsorption in 4 of 8 of these same patients. Conclusions: A significant proportion of asymptomatic patients with celiac sprue have abnormal celiac antibodies and fat or carbohydrate malabsorption. Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge.

Background & Aims: Undiagnosed patients with symptoms of celiac sprue often present to physicians after establishing dietary gluten exclusion. Although they must resume a gluten-containing diet for evaluation, there are no guidelines regarding duration of the gluten challenge, gluten dose, or monitoring parameters. We investigated the effects of a short-term gluten challenge in asymptomatic treated adult celiac patients on intestinal absorption and celiac antibody tests. Methods: Eight adult asymptomatic celiac patients consumed either 5 or 10 g of partially hydrolyzed gluten per day in an orange juice mixture for 21 days while maintaining their usual gluten-free diet. A symptom questionnaire, serum antibodies (antigliadin immunoglobulin [Ig]A and antitransglutaminase IgA and IgG), D-xylose urine excretion test, and 72-hour quantitative fecal fat test were monitored. Results: Two patients (25%) had at least 1 abnormal celiac antibody test at baseline. There was no increase in antibodies during gluten exposure compared with baseline for any of the patients (P > .05). At baseline, 1 patient had abnormal urine xylose excretion, and 3 patients had abnormal fecal fat values. At day 15 of gluten challenge, all patients had reduced xylose absorption compared with baseline (P = .0019), and 5 of 8 participants (63%) reduced their xylose excretion to the abnormal range. Seven of 8 patients (88%) had increased fecal fat excretion at day 15 (P = .026), and 6 of these (75%) had steatorrhea by day 15. Conclusions: Short-term gluten challenge in asymptomatic adult celiac patients produces carbohydrate and fat malabsorption but does not increase transglutaminase and antigliadin antibody titers.

This article describes the development and field-testing of an observational tool, the Volunteer Tutor Instructional Practices Checklist. It is an example of action research in a clinical setting and will be of interest to all educators, including special education and reading center directors, in the training and ongoing supervision of community literacy volunteer tutors and preservice teachers. The tutees may be elementary or middle school age. The development of the instrument, reliability data, variety of uses, and administration and scoring are discussed.

This study examined attitudes and concerns related to the use of alternative assessments in literacy education courses. A Likert-style twenty-item questionnaire was developed and administered first as a pilot to determine item quality and dimensionality. Three subscales were identified: Self-Evaluation, Peer Evaluation, and Instructor Modeling. The questionnaire was then administered to two sections of one literacy assessment course as pre- and post-course assessments. The results were significant for Self-Evaluation and Peer Evaluation. Results for Instructor Modeling did not reach significance but were generally positive in support of modeling alternative assessment in education classes. Qualitative analysis of respondent comments supported the statistical findings.

© 2014, Springer International Publishing Switzerland.Purpose: To be patient-centered, assessment must extract what patients prefer to be able to do along with what they can do now so health care can specifically address the gap between current and preferred abilities. In this project, we compared patient-perceived current–preferred gaps with the assessments and interventions reported by clinicians in a rehabilitation clinic.Methods: Sixty-two patients in outpatient physical therapy completed a computer-adaptive test version of the patient-reported Movement Ability Measure (MAM-CAT) at initial visit and discharge. The MAM-CAT calculated the gaps between the movement patients perceived that they could do “Now” and what movement ability they “Would Like” to have across six dimensions of movement: flexibility, strength, accuracy, speed, adaptability, and endurance. Physical therapists’ notes regarding assessments and interventions were categorized based on these same six dimensions of movement. Frequency of agreement between the largest patient-perceived gaps and clinician-documented emphases was recorded (kappa analyses), along with MAM-CAT changes at discharge (paired t tests).Results: Although patient progress was noted in both the MAM-CAT and the clinician notes (p

Spinal manual therapy (SMT) is commonly used for treatment of musculoskeletal pain in the neck, upper back, or upper extremity. Some authors report a multi-system effect of SMT, including peripheral alterations in skin conductance and skin temperature, suggesting that SMT may initiate a sympathetic nervous system (SNS) response. The focus of this evidence-based review and meta-analysis is to evaluate the evidence of SNS responses and clinically relevant outcomes following SMT to the cervical or thoracic spine.A SYSTEMATIC SEARCH USED THE TERMS: 'manual therapy', 'SMT', 'spinal manipulation', 'mobilization', 'SNS', 'autonomic nervous system', 'neurophysiology', 'hypoalgesia', 'pain pathophysiology', 'cervical vertebrae', 'thoracic vertebrae', 'upper extremity', and 'neurodynamic test'. Data were extracted and within-group and between-group effect sizes were calculated for outcomes of skin conductance, skin temperature, pain, and upper extremity range of motion (ROM) during upper limb neurodynamic tests (ULNTs).Eleven studies were identified. Statistically significant changes were seen with increased skin conductance, decreased skin temperature, decreased pain, and increased upper extremity ROM during ULNT.A mechanical stimulus at the cervical or thoracic spine can produce a SNS excitatory response (increased skin conductance and decreased skin temperature). Findings of reduced pain and increased ROM during ULNT provide support to the clinical relevance of SMT. This evidence points toward additional mechanisms underlying the therapeutic effect of SMT. The effect sizes are small to moderate and no long-term effects post-SMT were collected. Future research is needed to associate peripheral effects with a possible centrally-mediated response to SMT.