scholarly journals Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke

2016 ◽  
Vol 96 (10) ◽  
pp. 1648-1657 ◽  
Author(s):  
Kimberly J. Miller ◽  
Courtney L. Pollock ◽  
Brenda Brouwer ◽  
S. Jayne Garland
Keyword(s):  
Confidence Interval ◽  
Item Response ◽  
Response Bias ◽  
Repeated Measures ◽  
Rasch Analysis ◽  
Task Demands ◽  
Community Dwelling ◽  
Clinical Population ◽  
Sensitivity To Change ◽  
Walking Balance

AbstractBackgroundThe Community Balance and Mobility Scale (CB&M) is increasingly used to evaluate walking balance following stroke.ObjectiveThis study applied Rasch analysis to evaluate and refine the CB&M for use in ambulatory community-dwelling adults following stroke.MethodsThe CB&M content was linked to task demands and motor skill classifications. Rasch analysis was used to evaluate internal construct validity (structural validity) and refine the CB&M for use with ambulatory community-dwelling adults following stroke. The CB&M data were collected at 3 time points: at discharge from inpatient rehabilitation and at 6 and 12 months postdischarge (N=238). Rasch analysis evaluated scale dimensionality, item and person fit, item response bias, scoring hierarchy, and targeting. Disordered scoring hierarchy was resolved by collapsing scoring categories. Highly correlated and “misfitting” items were removed. Sensitivity to change was evaluated with standardized response means (SRMs) and one-way repeated-measures analysis of variance.ResultsThe CB&M was primarily linked to closed body transport task demands. Significant item-trait interaction, disordered scoring hierarchies, and multidimensionality were found. Scoring categories were collapsed in 15/19 items, and 5 misfitting items were removed. The resulting stroke-specific 14-item unidimensional CB&M (CB&MStroke) fit Rasch model expectations, with no item response bias, acceptable targeting (13% floor effects and 0% ceiling effects), and moderate-to-strong sensitivity to change at 6 months postdischarge (SRM=0.63; 95% confidence interval=−1.523, −0.142) and 12 months postdischarge (SRM=0.73; 95% confidence interval=−2.318, −0.760).LimitationsFindings are limited to a modest-sized sample of individuals with mild-to-moderate balance impairment following stroke.ConclusionsThe CB&MStroke shows promise as a clinical scale for measuring change in walking balance in ambulatory community-dwelling adults poststroke. Future studies are recommended in a larger sample to validate and further refine the scale for use in this clinical population.

scholarly journals Plasma acylcarnitines and risk of lower-extremity functional impairment in older adults: a nested case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Félix Caballero ◽  
Ellen A. Struijk ◽  
Alberto Lana ◽  
Antonio Buño ◽  
Fernando Rodríguez-Artalejo ◽  
...  
Keyword(s):  
Older Adults ◽  
Confidence Interval ◽  
Lower Extremity ◽  
Functional Impairment ◽  
Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Community Dwelling ◽  
Control Study ◽  
Long Chain

AbstractElevated concentrations of acylcarnitines have been associated with higher risk of obesity, type 2 diabetes and cardiovascular disease. The aim of the present study was to assess the association between L-carnitine and acylcarnitine profiles, and 2-year risk of incident lower-extremity functional impairment (LEFI). This case–control study is nested in the Seniors-ENRICA cohort of community-dwelling older adults, which included 43 incident cases of LEFI and 86 age- and sex- matched controls. LEFI was assessed with the Short Physical Performance Battery. Plasma L-carnitine and 28 acylcarnitine species were measured. After adjusting for potential confounders, medium-chain acylcarnitines levels were associated with 2-year incidence of LEFI [odds ratio per 1-SD increase: 1.69; 95% confidence interval: 1.08, 2.64; p = 0.02]. Similar results were observed for long-chain acylcarnitines [odds ratio per 1-SD increase: 1.70; 95% confidence interval: 1.03, 2.80; p = 0.04]. Stratified analyses showed a stronger association between medium- and long-chain acylcarnitines and incidence of LEFI among those with body mass index and energy intake below the median value. In conclusion, higher plasma concentrations of medium- and long-chain acylcarnitines were associated with higher risk of LEFI. Given the role of these molecules on mitochondrial transport of fatty acids, our results suggest that bioenergetics dysbalance contributes to LEFI.

Effectiveness of a Care Delivery Model for High-Need Older Adults in Communities

2020 ◽  
pp. 104973152098235
Author(s):  
Kuei-Min Chen ◽  
Hui-Fen Hsu ◽  
Li-Yen Yang ◽  
Chiang-Ching Chang ◽  
Yu-Ming Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Repeated Measures ◽  
Comparison Group ◽  
Care Delivery ◽  
Intervention Group ◽  
Community Dwelling ◽  
Delivery Model ◽  
Positive Effects ◽  
Repeated Measures Design ◽  
Care Delivery Model

Purpose: This study aimed to test the effectiveness of High-Need Community-Dwelling Older Adults Care Delivery Model (HCOACDM) in Taiwan. Methods: A cluster randomized controlled trial with repeated measures design was conducted in eight community care centers, involving 145 high-need older adults who were assigned to the intervention group or comparison group. The HCOACDM was provided over 6 months. Functional ability, quality of life, depressive symptoms, and health care and social service utilizations were measured at baseline, at 3 months, and 6 months into the intervention. The participants’ satisfaction was measured at the end of 6-month intervention. Results: Positive effects were shown on all variables in the intervention group at both the 3-month and 6-month intervals (all p < .05). The intervention group had a higher satisfaction with care delivery than the comparison group ( p < .05). Discussion: The promising findings supported a long-term implementation of the HCOACDM as applicable and beneficial.

scholarly journals Factors associated to functioning and health in relation to home rehabilitation in Sweden: a non-randomized pre-post intervention study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anette Johansson ◽  
Marie Ernsth Bravell ◽  
Eleonor I. Fransson ◽  
Sofi Fristedt
Keyword(s):  
Repeated Measures ◽  
Linear Models ◽  
Medical Condition ◽  
Rehabilitation Program ◽  
Community Dwelling ◽  
Rehabilitation Service ◽  
Post Intervention ◽  
Factors Associated ◽  
Rehabilitation Outcomes ◽  
Self Rated Health

Abstract Background Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program. Method The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome. Result Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes. Conclusion The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.

Two-Year Repeated Study on Health Effect of Net-Step Exercise Program in Community-Dwelling Older Persons

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Mori M ◽  
◽  
Seko T ◽  
Ogawa S ◽  
Kitazawa K ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Older Persons ◽  
Smoking Status ◽  
Health Effect ◽  
Exercise Program ◽  
Community Dwelling ◽  
Confounding Variables ◽  
One Year ◽  
Male Subjects ◽  
Female Subjects

Background: A light-burden and indoor physical exercise program called Net-Step Exercise (NSE) has been developed in Hokkaido, Japan. Conducting the two-year repeated survey with the Kihon Checklist (KCL) for the same older subjects living in a rural area of Hokkaido where a relatively large proportion of the older persons have participated in NSE activity, we assessed the effectiveness of NSE activity. Methods: The whole of 3,155 community-dwelling persons aged from 75 years to 79 years in 8 towns were the candidates of the study subjects, and 2,183 subjects (69.2%) responded to the first survey (2018 Survey), answering the questions about both frequency of participation in NSE and each item in KCL. The same survey (2019 Survey) was conducted one year later, and completed by 1,956 subjects (93.3%), excluding 25 dead persons or 60 persons who had moved away from the community during the year. In the 2018 Survey as well as the 2019 Survey, Adjusted Odds Ratio (AOR) and its 95% confidence interval (95%CI) of each sub-category of KCL for NSE Participants compared with NSE Non-participants was calculated with unconditional logistic regression by sex, adjusting for age, smoking status, and other potentially confounding variables. Repeated-measures Analysis of Variance (ANOVA) was also applied by sex. Results: Significantly reduced risk (AOR with 95% CI) was observed in NSE participants in difficulty in activities of daily living in the male subjects in the 2018 Survey (0.64, 0.42-0.98) and in the 2019 Survey (0.50, 0.32-0.79), as well as in the female subjects in the 2018 Survey (0.52, 0.38-0.70) and in the 2019 Survey (0.46, 0.33-0.65), houseboundness in the female subjects in the 2018 Survey (0.42, 0.29-0.60) and in the 2019 Survey (0.70, 0.51-0.96), impaired cognitive function in the male subjects in the 2018 Survey (0.58, 0.36-0.92), and depressive status in the female subjects in the 2018 Survey (0.66, 0.49-0.88). Significant findings were also shown in most of the above four sub-categories by analysis with repeated-measures ANOVA. Conclusion: Either performance of NSE itself or participation in the program, or both, may promote healthy status in the older persons.

Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments

2009 ◽  
Vol 18 (5-6) ◽  
pp. 295-303
Author(s):  
Helen S. Cohen ◽  
Kay T. Kimball
Keyword(s):  
Sensitivity And Specificity ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Vestibular Disorders ◽  
Timed Up And Go ◽  
Balance Tests ◽  
Walking Balance

The goal of this study was to determine which of several clinical balance tests best identifies patients with vestibular disorders. We compared the scores of normals and patients on the Berg Balance Scale (Berg), Dynamic Gait Index (DGI), Timed Up and Go (TUG), Computerized Dynamic Posturography Sensory Organization Test (SOT), and a new obstacle avoidance test: the Functional Mobility Test (FMT). The study was performed in an out-patient balance laboratory at a tertiary care center. Subjects were 40 normal adults, and 40 adults with vestibular impairments. The main outcome measures were the sensitivity of tests to patients and specificity to normals. When adjusted for age the Berg, TUG, DGI and FMT had moderate sensitivity and specificity. SOT had moderately high sensitivity and specificity. SOT and FMT, combined, had high sensitivity and moderate specificity. Therefore, the kinds of tests of standing and walking balance that clinicians may use to screen patients for falling are not as good for screening for vestibular disorders as SOT. SOT combined with FMT is better. When screening patients for vestibular disorders, when objective diagnostic tests of the vestibular system, itself, are unavailable, tests of both standing and walking balance, together, give the most information about community-dwelling patients. These tests may also indicate the presence of sub-clinical balance problems in community-dwelling, asymptomatic adults.

scholarly journals Associations Between Control Beliefs and Response Time Inconsistency in Older Adults Vary as a Function of Attentional Task Demands

2018 ◽  
Vol 75 (9) ◽  
pp. 1819-1830
Author(s):  
Eric S Cerino ◽  
Robert S Stawski ◽  
G John Geldhof ◽  
Stuart W S MacDonald
Keyword(s):  
Older Adults ◽  
Locus Of Control ◽  
Response Time ◽  
Cognitive Aging ◽  
Perceived Competence ◽  
Task Demands ◽  
Community Dwelling ◽  
Time Inconsistency ◽  
Control Beliefs ◽  
Choice Response

Abstract Objective Control beliefs are established correlates of cognitive aging. Despite recent demonstrations that response time inconsistency (RTI) represents a proxy for cognitive processing efficiency, few investigations have explored links between RTI and psychosocial correlates. We examined associations among RTI and control beliefs (perceived competence and locus of control) for two choice-response time (RT) tasks varying in their attentional demands. Method Control beliefs and RTI were measured weekly for 5 weeks in a sample of 304 community-dwelling older adults (Mage = 74.11 years, SD = 6.05, range = 64–92, 68.58% female). Results Multilevel models revealed that for the attentionally demanding task, reporting higher perceived competence than usual was associated with lower RTI for relatively younger participants and greater RTI for relatively older participants. For the less attentionally demanding task, reporting higher perceived competence than usual was associated with lower RTI for relatively older participants. Links between locus of control and RTI were comparatively scant. Discussion Our findings suggest that control beliefs may have adaptive and maladaptive influences on RTI, depending on dimension of control beliefs, individual differences in level of control beliefs and age, as well as attentional task demands. Both for whom and when control beliefs can be leveraged to optimize cognitive aging are discussed.

scholarly journals Use of Item Response Theory to Examine a Cardiovascular Health Knowledge Measure for Adolescents with Elevated Blood Pressure

2012 ◽  
Vol 3 (1) ◽  
pp. 27 ◽  
Author(s):  
Stephanie L. Fitzpatrick ◽  
Patrick G. Saab ◽  
Maria M. Llabre ◽  
Randall Penfield ◽  
Judith R. McCalla ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Item Response Theory ◽  
Item Response ◽  
Rasch Analysis ◽  
Cardiovascular Health ◽  
Health Knowledge ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Response Theory ◽  
Post Intervention

The purpose of this study was to assess the psychometric properties of a cardiovascular health knowledge measure for adolescents using item response theory. The measure was developed in the context of a cardiovascular lifestyle intervention for adolescents with elevated blood pressure. Sample consisted of 167 adolescents (mean age = 16.2 years) who completed the Cardiovascular Health Knowledge Assessment (CHKA), a 34-item multiple choice test, at baseline and post-intervention. The CHKA was unidimensional and internal consistency was .65 at pretest and .74 at posttest. Rasch analysis results indicated that at pretest the items targeted adolescents with variable levels of health knowledge. However, based on results at posttest, additional hard items are needed to account for the increase in level of cardiovascular health knowledge at post-intervention. Change in knowledge scores was examined using Rasch analysis. Findings indicated there was significant improvement in health knowledge over time [t(119) = -10.3, p< .0001]. In summary, the CHKA appears to contain items that are good approximations of the construct cardiovascular health knowledge and items that target adolescents with moderate levels of knowledge.  DOI:10.2458/azu_jmmss_v3i1_fitzpatrick

Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Bo Qin ◽  
Anthony J Viera ◽  
Linda S Adair ◽  
Brenda L Plassman ◽  
Lloyd J Edwards ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Verbal Memory ◽  
Repeated Measures ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Cognitive Test ◽  
Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

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