Psychometric Evaluation of an ICF-Based Instrumental Activities of Daily Living Assessment With Older Adults With Cognitive Decline.

IMPORTANCE: Identifying cognitive or physical limitations that contribute to difficulties in instrumental activities of daily living (IADLs) is critical for adequate intervention with community-dwelling older adults with cognitive decline. OBJECTIVE: To establish the validity and responsiveness of an IADL scale based on the International Classification of Functioning, Disability and Health (the ICF-IADL) with respect to both cognitive and physical limitations. DESIGN: Cross-sectional study. SETTING: Multiple community care and senior centers. PARTICIPANTS: Eighty-two older adults. INTERVENTION: Combination of physical exercise and cognitive training. MEASURES: Five criterion measures-Lawton IADL Scale, Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSS), Word Lists Test (WLT), and Timed Up and Go Test (TUG). RESULTS: The ICF-IADL's three summary scales-Disability Index (DI), Cognitive Disability Index (CDI), and Physical Disability Index (PDI)-had good concurrent validity with the Lawton IADL Scale. The DI and CDI had moderate to good associations with the MoCA. The DI's and CDI's predictive validity for scores on the Lawton IADL Scale, MoCA, and TUG was moderate to good and that of the PDI was fair. Responsiveness was large for the DI, moderate for the CDI, and small for the PDI. CONCLUSIONS AND RELEVANCE: The ICF-IADL can be used to measure disability in IADLs related to cognitive and physical limitations. The DI and CDI were better than the PDI in predicting outcomes in general cognitive function and dynamic balance and were more responsive to change after intervention than the PDI. WHAT THIS ARTICLE ADDS: The ICF-IADL addresses both cognitive and physical limitations and can be a valid assessment of IADLs. Occupational therapists can use it to determine difficulties in IADLs and causes of those difficulties, guide treatment planning, and monitor intervention effectiveness with community-dwelling older adults with cognitive decline.

Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke.

OBJECTIVE: We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD: In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS: The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION: The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

The Active Ingredient of Cognitive Restoration: A Multicenter Randomized Controlled Trial of Sequential Combination of Aerobic Exercise and Computer-Based Cognitive Training in Stroke Survivors With Cognitive Decline.

OBJECTIVE: To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline. DESIGN: Intervention study and randomized controlled trial. SETTING: Hospital-based rehabilitation units. PARTICIPANTS: Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group. INTERVENTIONS: The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities. MAIN OUTCOME MEASURES: The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life. RESULTS: Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both). CONCLUSIONS: Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy.

Synergistic effects of aerobic exercise and cognitive training on cognition, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline: study protocol for a randomized controlled trial.

BACKGROUND: Aerobic exercise and cognitive training have been effective in improving cognitive functions; however, whether the combination of these two can further enhance cognition and clinical outcomes in stroke survivors with cognitive decline remains unknown. This study aimed to determine the treatment effects of a sequential combination of aerobic exercise and cognitive training on cognitive function and clinical outcomes. METHODS/DESIGN: Stroke survivors (n = 75) with cognitive decline will be recruited and randomly assigned to cognitive training, aerobic exercise, and sequential combination of aerobic exercise and cognitive training groups. All participants will receive training for 60 minutes per day, 3 days per week for 12 weeks. The aerobic exercise group will receive stationary bicycle training, the cognitive training group will receive cognitive-based training, and the sequential group will first receive 30 minutes of aerobic exercise, followed by 30 minutes of cognitive training. The outcome measures involve cognitive functions, physiological biomarkers, daily function and quality of life, physical functions, and social participation. Participants will be assessed before and immediately after the interventions, and 6 months after the interventions. Repeated measures of analysis of variance will be used to evaluate the changes in outcome measures at the three assessments. DISCUSSION: This trial aims to explore the benefits of innovative intervention approaches to improve the cognitive function, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline. The findings will provide evidence to advance post-stroke cognitive rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02550990 . Registered on 6 September 2015.

Evolving methods to combine cognitive and physical training for individuals with mild cognitive impairment: study protocol for a randomized controlled study.

BACKGROUND: Nonpharmacologic interventions, such as cognitive training or physical exercise, are effective in improving cognitive functions for older adults with mild cognitive impairment (MCI). Some researchers have proposed that combining physical exercise with cognitive training may augment the benefits of cognition. However, strong evidence is lacking regarding whether a combined therapy is superior to a single type of training for older adults with MCI. Moreover, which combination approach - combining physical exercise with cognitive training sequentially or simultaneously - is more advantageous for cognitive improvement is not yet clear. This proposed study is designed to clarify these questions. METHODS/DESIGN: This study is a single-blinded, multicenter, randomized controlled trial. Eighty individuals with MCI will be recruited and randomly assigned to cognitive training (COG), physical exercise training (PE), sequential training (SEQ), and dual-task training (DUAL) groups. The intervention programs will be 90 min/day, 2-3 days/week, for a total of 36 training sessions. The participants in the SEQ group will first perform 45 min of physical exercise followed by 45 min of cognitive training, whereas those in the DUAL group will perform physical exercise and cognitive training simultaneously. Participants will be assessed at baseline, after the intervention, and at 6-month follow-up. The primary cognitive outcome tests will include the Montreal Cognitive Assessment and the color-naming Stroop test. Other outcomes will include assessments that evaluate the cognitive, physical, and daily functions of older adults with MCI. DISCUSSION: The results of this proposed study will provide important information regarding the feasibility and intervention effects of combining physical exercise and cognitive training for older individuals with MCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02512627 , registered on 20 July 2015.

Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation.

OBJECTIVE: This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke. METHOD: The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA-S) and motor subscale (FMA-M) and the Nottingham Extended Activities of Daily Living (NEADL) scale. RESULTS: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA-M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51-.83). CONCLUSION: This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

Proximal Fugl-Meyer Assessment Scores Predict Clinically Important Upper Limb Improvement After 3 Stroke Rehabilitative Interventions.

OBJECTIVE: To identify the baseline motor characteristics of the patients who responded to 3 prominent intervention programs. DESIGN: Observational cohort study. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Individuals with chronic stroke (N=174). INTERVENTIONS: Participants received 30 hours of constraint-induced movement therapy (CIMT), robot-assisted therapy, or mirror therapy (MT). MAIN OUTCOME MEASURES: The primary outcome measure was the change score of the Upper Extremity Fugl-Meyer Assessment (UE-FMA). The potential predicting variables were baseline proximal, distal, and total UE-FMA and Action Research Arm Test scores. We combined polynomial regression analyses and the minimal clinically important difference to stratify the patients as responders and nonresponders for each intervention approach. RESULTS: Baseline proximal UE-FMA scores significantly predicted clinically important improvement on the primary outcome measure after all 3 interventions. Participants with baseline proximal UE-FMA scores of approximately <30 benefited significantly from CIMT and robot-assisted therapy, whereas participants with scores between 21 and 35 demonstrated significant improvement after MT. Baseline distal and total UE-FMA and Action Research Arm Test scores could also predict upper limb improvement after CIMT and MT, but not after robot-assisted therapy. CONCLUSIONS: This study could inform clinicians about the selection of suitable rehabilitation approaches to help patients achieve clinically meaningful improvement in upper extremity function.

Clinimetric properties of the Assessment of Preschool Children's Participation in children with cerebral palsy.

This study examines the criterion-related validity and clinimetric properties of the Assessment of Preschool Children's Participation (APCP) for children with cerebral palsy (CP). Eighty-two children with CP (age range, two to five years and 11 months) and their caregivers participated in this study. The APCP consists of diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation (AP), social activities (SA), and total areas. Tests were administered at baseline and at six-month follow-up. Concurrent and predictive validities were identified by assessing the strength of correlations between APCP scores and criterion-related measures--the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measure for Children (WeeFIM). Responsiveness was measured by standardized response mean (SRM). Minimal detectable change (MDC) at the 95% confidence level (MDC95) and minimal clinically important difference (MCID) were analyzed. The APCP with GMFM-66 and WeeFIM had fair to excellent concurrent validity (r=0.39-0.85) and predictive validity (r=0.46-0.82). The SRM values of the APCP diversity and intensity scales in all areas were 0.8-1.3. The MDC95 and MCID ranges for all areas (i.e., PA, SD, AP, SA, and total areas) were 0.1-0.7 and 0.4-1.2 points for intensity scores, respectively, and 4-17% and 10-19% for diversity scores, respectively. Therefore, the APCP scale was markedly responsive to change. Clinicians and researchers can use these clinimetric APCP data to determine whether a change score represents a "true" or clinically meaningful effect at post-treatment and follow-up.

Psychometric comparison of the shortened Fugl-Meyer Assessment and the streamlined Wolf Motor Function Test in stroke rehabilitation.

OBJECTIVE: We aimed to compare the responsiveness, concurrent and predictive validity of the shortened Fugl-Meyer Assessment (S-FMA) and the streamlined Wolf Motor Function Test (S-WMFT) in persons with subacute stroke. DESIGN: Test-retest design. SETTING: Departments of physical medicine and rehabilitation at three hospitals. PARTICIPANTS: PARTICIPANTS with first-time stroke (N = 51; 38 men, 13 women; mean age ± SD, 55.1 ± 11.7 years) based on scores of Mini-Mental State Examination and Brunnstrom stage. INTERVENTIONS: PARTICIPANTS received one of three rehabilitation therapies for three weeks and were evaluated at baseline and end of treatment. MAIN OUTCOME MEASURES: Responsiveness was examined using the paired t-test and the standardized response mean (SRM). Criterion validity was investigated using the Pearson's correlation coefficient (r). RESULTS: Changes from baseline to end of treatment assessed by both tests were significant (P < 0.001). The value for responsiveness of the S-FMA was significantly higher than that of the S-WMFT (SRM difference, 0.48; 95% confidence interval, 0.23-0.63). There were stronger associations between the comparison scales and the S-FMA (r = 0.57-0.68) than with the S-WMFT (r = 0.39-0.58). CONCLUSIONS: The S-FMA had better concurrent and predictive validity than the S-WMFT and was more sensitive to changes caused by rehabilitation therapies. The S-FMA is recommended for expedited assessment of arm motor function outcome in stroke patients receiving rehabilitative therapy.