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To investigate the psychometric properties of the activities of daily living (ADL) instrument used in the analysis of Korean Longitudinal Study of Ageing (KLoSA) dataset.
A retrospective study was carried out involving 2006 KLoSA records of community-dwelling adults diagnosed with stroke. The ADL instrument used for the analysis of KLoSA included 17 items, which were analyzed using Rasch modeling to develop a robust outcome measure. The unidimensionality of the ADL instrument was examined based on confirmatory factor analysis with a one-factor model. Item-level psychometric analysis of the ADL instrument included fit statistics, internal consistency, precision, and the item difficulty hierarchy.
The study sample included a total of 201 community-dwelling adults (1.5% of the Korean population with an age over 45 years; mean age=70.0 years, SD=9.7) having a history of stroke. The ADL instrument demonstrated unidimensional construct. Two misfit items, money management (mean square [MnSq]=1.56, standardized Z-statistics [ZSTD]=2.3) and phone use (MnSq=1.78, ZSTD=2.3) were removed from the analysis. The remaining 15 items demonstrated good item fit, high internal consistency (person reliability=0.91), and good precision (person strata=3.48). The instrument precisely estimated person measures within a wide range of theta (−4.75 logits < θ < 3.97 logits) and a reliability of 0.9, with a conceptual hierarchy of item difficulty.
The findings indicate that the 15 ADL items met Rasch expectations of unidimensionality and demonstrated good psychometric properties. It is proposed that the validated ADL instrument can be used as a primary outcome measure for assessing longitudinal disability trajectories in the Korean adult population and can be employed for comparative analysis of international disability across national aging studies.
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To evaluate the validity of the Test of Infant Motor Performance (TIMP) and general movements (GMs) assessment for predicting Alberta Infant Motor Scale (AIMS) score at 12 months in preterm infants.
A total of 44 preterm infants who underwent the GMs and TIMP at 1 month and 3 months of corrected age (CA) and whose motor performance was evaluated using AIMS at 12 months CA were included. GMs were judged as abnormal on basis of poor repertoire or cramped-synchronized movements at 1 month CA and abnormal or absent fidgety movement at 3 months CA. TIMP and AIMS scores were categorized as normal (average and low average and >5th percentile, respectively) or abnormal (below average and far below average or <5th percentile, respectively). Correlations between GMs and TIMP scores at 1 month and 3 months CA and the AIMS classification at 12 months CA were examined.
The TIMP score at 3 months CA and GMs at 1 month and 3 months CA were significantly correlated with the motor performance at 12 months CA. However, the TIMP score at 1 month CA did not correlate with the AIMS classification at 12 months CA. For infants with normal GMs at 3 months CA, the TIMP score at 3 months CA correlated significantly with the AIMS classification at 12 months CA.
Our findings suggest that neuromotor assessment using GMs and TIMP could be useful to identify preterm infants who are likely to benefit from intervention.
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To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment.
This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups.
Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04–0.46; p=0.001).
In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.
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To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation.
We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke.
Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R2=0.646).
In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.
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The Applicability of the Patient-Specific Functional Scale (PSFS) in Rehabilitation for Patients with Acquired Brain Injury (ABI) – A Cohort Study
To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke.
Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis.
The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS.
Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.
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To follow up the long-term functioning in a community through assessing personal background and status based on the International Classification of Functioning, Disability and Health (ICF) after a stroke, by using a Korean version of World Health Organization Disability Assessment Scale II (K-WHODAS II).
We surveyed 146 patients diagnosed at the first-onset of acute stroke and discharged after Inha University Hospital, and 101 patients answered the K-WHODAS II survey. We analyzed the relationship of six functioning domains of K-WHODAS II with K-MMSE (Korean version of Mini-Mental State Examination) and K-MBI (Korean version of Modified Barthel Index) at admission and discharge, and personal background. All subjects were divided into five groups, according to the disease durations, to assess the functional changes and the differences of K-MMSE and K-MBI at the admission and discharge.
K-MBI and K-MMSE at admission and discharge showed no significant differences in all five groups, respectively (p>0.05), reflecting no baseline disparity for long-term follow-up. All subjects showed positive gains of K-MBI and K-MMSE at discharge (p<0.05). The six functioning domains and total scores of K-WHODAS II had decreasing trends until 3 years after the stroke onset, but rose thereafter. Higher scores of K-MBI and K-MMSE, younger age, women, working status, higher educational level, and living with a partner were correlated with lower scores of K-WHODAS II (p<0.05).
The long-term functioning after stroke was affected not only by cognitive and motor status in hospital, but also by certain kinds of personal background. K-WHODAS II may be used to monitor functioning status in a community and to assess personal backgrounds in subjects with chronic stroke.
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To develop a quantitative and organ-specific practical test for the diagnosis and treatment of dysphagia based on assessment of stroke patients.
An initial test composed of 24 items was designed to evaluate the function of the organs involved in swallowing. The grading system of the initial test was based on the analysis of 50 normal adults. The initial test was performed in 52 stroke patients with clinical symptoms of dysphagia. Aspiration was measured via a videofluoroscopic swallowing study (VFSS). The odds ratio was obtained to evaluate the correlation between each item in the initial test and the VFSS. A polychotomous linear logistic model was used to select the final test items.
Eighteen of 24 initial items were selected as significant for the final tests. These 18 showed high initial validity and reliability. The Spearman correlation coefficient for the total score of the test and functional dysphagia scale was 0.96 (p<0.001), indicating a statistically significant positive correlation.
This study was carried out to design a quantitative and organ-specific test that assesses the causes of dysphagia in stroke patients; therefore, this test is considered very useful and highly applicable to the diagnosis and treatment of dysphagia.
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To investigate the intra-rater and inter-rater reliability and usefulness of the Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) in ataxic stroke patients.
The original SARA was translated into Korean, back translated to English, and compared to the original version. Stroke patients (n=60) with ataxia were evaluated using the K-SARA by one physiatrist and one occupational therapist. All subjects were rated twice. We divided the subjects into 5 groups by Functional Ambulation Category (FAC) and 3 groups based on the ataxia subscale of the National Institutes of Health Stroke Scale (NIHSS). The mean K-SARA scores representing each group of FAC and the ataxia subscale of NIHSS were compared.
The test-retest correlation coefficient of the K-SARA was 0.997 by the therapist and 1.00 by the physiatrist (p<0.001). The inter-rater correlation coefficient of the K-SARA was 0.985 (p<0.001). The ataxia subscale of NIHSS did not correlate with K-SARA. There was a significant difference in the mean K-SARA score by FAC (p<0.001).
K-SARA is a reliable and valid measure of ataxia in stroke patients in Korea.
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To delineate cervical radiculopathy that is found in combination with traumatic cervical spinal cord injury (SCI) and to determine whether attendant cervical radiculopathy affects the prognosis and functional outcome for SCI patients.
A total of 66 patients diagnosed with traumatic cervical SCI were selected for neurological assessment (using the International Standards for the Neurological Classification of Spinal Cord Injury [ISNCSCI]) and functional evaluation (based on the Korean version Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]) at admission and upon discharge. All of the subjects received a preliminary electrophysiological assessment, according to which they were divided into two groups as follows: those with cervical radiculopathy (the SCI/Rad group) and those without (the SCI group).
A total of 32 patients with cervical SCI (48.5%) had cervical radiculopathy. The initial ISNCSCI scores for sensory and motor, K-MBI, and total FIM did not significantly differ between the SCI group and the SCI/Rad group. However, at discharge, the ISNCSCI scores for motor, K-MBI, and FIM of the SCI/Rad group showed less improvement (5.44±8.08, 15.19±19.39 and 10.84±11.49, respectively) than those of the SCI group (10.76±9.86, 24.79±19.65 and 17.76±15.84, respectively) (p<0.05). In the SCI/Rad group, the number of involved levels of cervical radiculopathy was negatively correlated with the initial and follow-up motors score by ISNCSCI.
Cervical radiculopathy is not rare in patients with traumatic cervical SCI, and it can impede neurological and functional improvement. Therefore, detection of combined cervical radiculopathy by electrophysiological assessment is essential for accurate prognosis of cervical SCI patients in the rehabilitation unit.
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To investigate disparities in the fear of falling between urban and rural communities in relation to socio-demographics, health status, and functional level.
A total of 974 subjects aged 40 years or older participated in this study (335 urban residents and 639 rural). They completed a questionnaire about socio-demographics, health-related variables, and experience with falls. We employed both direct questioning and the Korean version of Falls Efficacy Scale-International (KFES-I) to investigate fear of falling in terms of perceptive fear and higher level of concern over falling during daily activities. The Korean version of Instrumental Activities of Daily Living was used to assess functional independency.
Aging, female gender, fall history, and the presence of chronic medical problems were independently associated with higher prevalence for the fear of falling. Both perceptive fear of falling and a higher level of concern over falling were more prevalent in the rural senior population compared with those in the urban population when they had the following characteristics: lower income or educational background, physical laborer or unemployed, no chronic medical morbidity, or functional independency in daily activities.
The disparity in the fear of falling between the two areas is thought to be related to age structure, and it may also exist in healthy or functionally independent senior populations under the influence of socio-environmental factors. A senior population with lower socio-economic status residing in a rural area might be related with a greater vulnerability to the fear of falling. We should consider regional characteristics when we design fall-related studies or develop fall-prevention programs at the community level.
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To evaluate the clinical usefulness of the subjective assessments of nutritional status (Mini-Nutritional Assessment [MNA] and scored patient-generated subjective global assessment [PG-SGA]), compared with the objective (hematological, biochemical, and anthropometric) assessments, and to identify the correlation between the MNA and the scored PG-SGA in elderly patients with stroke.
Thirty-five stroke patients, aged 60 to 89 years old, participated in our study. The MNA, the scored PG-SGA and objective factors were evaluated. The objective malnutrition state was defined based on laboratory outcomes. According to the MNA and the scored PG-SGA classifications, total patients were respectively divided into three groups; well-nourished (W), at risk of malnutrition (R), and malnourished (M), and into four groups; normally nourished (A), suspected or mildly malnourished (B), moderately malnourished (C), and severely malnourished (D).
Mean age and body mass index of subjects were 70.6 years and 22.2 kg/m2, respectively. Twenty-six (74.3%) patients were identified to be at an objectively malnourished state. In MNA, 3 (8.6%) patients were classified as group W, 13 (37.1%) as R, and 19 (54.3%) as M. Total MNA scores and three categorization had mild correlation with objective grouping (r=0.383, r=0.350, p<0.05, respectively). Restructuring into two groups by combining group R and M made strong correlation (r=0.520, p<0.01). On the basis of scored PG-SGA, 6 (17.1%) patients were sorted as group A, 10 (28.6%) as B, 15 (42.9%) as C, and 4 (11.4%) as D, respectively. Total scores and the grouping into four indicated meaningful correlation with the objective distinction (r=-0.403, p<0.05, r=0.449, p<0.01, respectively). There was a significant correlation between the MNA scores and the PG-SGA scores (r=-0.651, p<0.01).
It is proposed that the MNA and the scored PG-SGA would be useful in screening malnourished elderly patients with stroke.
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To compare an objective assessment scale for "come-to-sit" in stroke patients with the previously established subjective assessment scales of "performance-based assessment" and the "ability for basic movement scale".
A specifically designed jacket was used to determine the objective degree of assistance needed for patients to perform the task. While patients were sitting up, the investigator evaluated the amount of assistance needed in a fully dependent state (A) and with maximal effort (B). Using this measure, we obtained an objective scale, {(A-B)/A} ×100. In addition, patients were tested in two starting positions: hemiplegic-side lying and sound-side lying. We then compared the objective scale with subjective scales and other parameters related to functional outcomes.
For both starting positions, the objective assessment scale showed high correlation with the previously established subjective scales (p<0.01). Only the hemiplegic-side lying-to-sit objective scale showed a significant correlation with the parameters used to assess functional outcomes (p<0.05). In terms of Brunnstrom stages, only the leg stage showed a significant correlation with the objective "come-to-sit" scale (p<0.01).
The objective scale was comparable to established subjective assessment scales when used by an expert. The hemiplegic-side lying-to-sit maneuver had a high correlation with patient's functional recovery. Specifically, balance and lower extremity function appear to be important factors in the "come-to-sit" activity.
To examine the usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in ataxic stroke patients.
This was a retrospective study of 54 patients following their first ataxic stroke. The data used in the analysis comprised ambulation status on admission and scores on the SARA, the Korean version of the Modified Barthel Index (K-MBI) and the Berg Balance Scale (BBS). The subjects were divided into four groups by gait status and into five groups by level of dependency in activities of daily living (ADLs) based on their K-MBI scores. Data were subjected to a ROC curve analysis to obtain cutoff values on the SARA for individual gait status and levels of activity dependency. The correlations between the SARA, K-MBI and BBS scores were also computed.
There was significant correlation between the SARA and the K-MBI scores (p<0.001), and this correlation (r=-0.792) was higher than that found between the BBS and the K-MBI scores (r=0.710). The SARA scores of upper extremity ataxia categories were significantly related to the K-MBI scores of upper extremity related function (p<0.001). The SARA scores were also significantly correlated negatively with ambulation status (p<0.001) and positively with ADL dependency (p<0.001). In the ROC analysis, patients with less than 5.5 points on the SARA had minimal dependency in ADL, while those with more than 23 points showed total dependency.
SARA corresponds well with gait status and ADL dependency in ataxic stroke patients and is considered to be a useful functional measure in that patient group.
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To determine the degree of disparity in unmet healthcare needs between people with disabilities and the general population in South Korea, and to analyze their perspective reasons.
Survey results of 9,744 subjects that participated in the 4th Korea National Health and Nutrition Examination Survey and 7,000 people that participated in the 2008 Survey of Disabled people were used in this population-based cross-sectional study. Unmet healthcare needs were identified as reporting experience during the last 12 months when there was a need to see a doctor, but were unable to get it. We assessed unmet healthcare needs by demographic variables, social variables and characteristics of disability. Chi-square test and logistic regression were used to determine which variables were related to unmet healthcare needs.
A total of 22.1% of people with disabilities and 22.8% of the general population had unmet healthcare needs. However, brain impairment (25.3%) and physical impairment (25.2%) had more unmet healthcare needs than the general population and other disabilities. Unmet healthcare needs of people with disabilities was related to sex, age, self-perceived health, marital status, income, occupation and category of disability. Whereas the reasons for unmet healthcare needs in people with disabilities were lack of money (57.3%) and inaccessible transportation (12.8%), those for the general population were no available time (30.2%) and mild symptoms (23.8%).
Brain and physical impairment cases with limitations to accessible transportation had the higher unmet healthcare needs. In addition, the reasons for people with these disabilities were more environmental than those of the general population.
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To investigate the clinical usefulness of the Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia by comparing findings of SOMA with those of the videofluoroscopic swallowing study (VFSS).
Both SOMA and VFSS were performed in 33 children with dysphagia (21 boys and 12 girls; mean age 17.3±12.1 months) who were referred for oropharyngeal evaluation. Ratings of oral-motor functions indicated by SOMA were based upon the cutting score of each specific texture of food (puree, semi-solids, solids, cracker, liquid-bottle, and liquid-cup). Abnormalities of either the oral phase, or the pharyngeal phase as indicated by VFSS were assessed by a physician and a speech-language pathologist.
There was significant consistency between the findings of SOMA and the oral phase evaluation by VFSS (Kappa=0.419, p=0.023). SOMA reached 87.5% sensitivity, 66.6% specificity, and 95.4% positive predictive value when compared with the oral phase of the VFSS. We were able to evaluate oral-motor function by using SOMA in 6 children who were unable to complete the oral phase evaluation by VFSS, due to fear and crying during the study. The findings of SOMA failed to show any consistency with the pharyngeal phase evaluation by VFSS (Kappa=-0.105, p=0.509).
These results suggest that SOMA is a reliable method for evaluation of oral-motor function in children with dysphagia. In particular, SOMA is recommended for children that were unable to complete the oral phase evaluation by VFSS due to poor cooperation.
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