Modifying the Mobility Scale for Acute Stroke (MSAS) for All Stroke Phases (MSAllS): Measurement Properties and Clinical Application.

OBJECTIVE: To develop and examine the measurement properties and interpretability of the Mobility Scale for "All" Stroke Phases (MSAllS) as a potential single outcome measure to capture improvements in physical function throughout the stroke continuum. DESIGN: Retrospective cross-sectional study. SETTING: Inpatient rehabilitation unit. PARTICIPANTS: People after stroke at discharge from rehabilitation (N=309). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): We developed MSAllS by extending the highest MSAS level (walk 10 m independently) with 4 gait speed levels. To establish a clinical anchor, we extracted a 4-level discharge outcome. To assess the distributional properties and internal consistency of MSAllS, we evaluated its ceiling effects and calculated the Cronbach alpha, respectively. To assess structural validity, we performed a confirmatory factor analysis. To assess (i) its convergent validity with the FIM and (ii) its predictive validity with the clinical anchor, we used Spearman's rank correlations. To evaluate the clinical interpretability of MSAllS, we used an item-response theory-based method to estimate MSAllS thresholds associated with the clinical anchor. RESULTS: The MSAllS had lower ceiling effects compared with MSAS (0% vs 25%). Internal consistency of MSAllS was excellent (α=0.94). Structural validity of MSAllS demonstrated a good fit (Comparative Fit Index=0.95; Tucker-Lewis Index=0.92; Root Means Square Error of Approximation=0.17). MSAllS demonstrated a moderate correlation (rho=0.66) with FIM score and with the clinical anchor (rho=0.75). MSAllS thresholds for increasing levels of the clinical anchor were 22 (20.8 to 23.6) - at least moderate assistance with walking/transfers, 28 (27.5 to 29.4) - at most supervision with walking, and 33 (32.5 to 33.4) - able to walk unassisted. CONCLUSION: The MSAllS showed adequate measurement properties and clinical interpretability. MSAllS has the potential to be a single universal measure to evaluate physical function after stroke but further evaluation of clinical interpretability is required.

Effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care setting.

AIM: To examine the effectiveness of an integrated three-mode bed exit alarm system in reducing inpatient falls within an acute care hospital setting in Singapore. METHOD: A retrospective before-and-after study design was adopted. RESULTS: Our results revealed that the use of bed exit alarms are associated with a reduction in falls incidence. CONCLUSION: Bed exit alarm systems are associated with reduced fall incidence. Nonetheless, for an institution to benefit from the technology, there will be a need to take into account the effects of "alarm fatigue", ability of nurses to respond in time to alarms, and selection of right alarm mode/limits based on the patient's profile.

Investigating factors associated with quality of life of vitiligo patients in Singapore.

Skin disease is often visible to others. People who have dermatological condition may also suffer from its psychological consequences. The purpose of this study is to explore the quality of life of patients with vitiligo and to identify factors associated with their quality of life. A descriptive correlational study was conducted with 222 patients with vitiligo recruited from two skin centres in Singapore from 2009 to 2011. Data were collected by a structured questionnaire. Three outcome variables were measured in the study: predisposal, clinical and psychological outcomes. Results showed that almost two-thirds of the participants reported vitiligo had moderate to extreme impact on their quality of life. Multiple regression analyses showed that patients who were depressed, had thyroid disease and had not used multiclear treatment were more likely to report poor quality of life. It is recommended that providing health care consultation for patients with vitiligo may help reduce depressive symptoms and maintain their psychological health, thus enhance their quality of life.

The effectiveness of therapeutic interventions on quality of life for vitiligo patients: a systematic review.

This paper reviews the effectiveness of therapeutic interventions on quality of life for adult patients with vitiligo. We systematically searched nine databases from 1990 to February 2010 and reviewed randomized controlled trials and quasi-experimental studies of current therapeutic interventions for vitiligo, including oral, topical, combination, camouflage, cognitive-behavioural therapy and grafting. Quality of life outcomes were collected. The Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument was used for quality assessment. Nine studies were included for this review, and all treatments were found to improve quality of life for vitiligo patients. Disease-altering interventions were effective in improving quality of life. Lifestyle-altering interventions were found to be selectively effective for patients with more severe quality of life impairment. Current interventions for vitiligo are effective in improving quality of life either by enhancing physical appearance of the patient or by addressing the psychological distress directly. Less effectiveness was achieved for the functional and social dimensions, which are more dependent on social and cultural norms. This suggests that current interventions alone are inadequate to address the holistic quality of life challenges associated with vitiligo.

Investigating factors associated with depression of vitiligo patients in Singapore.

AIMS: To explore the depression level of a group of vitiligo patients in Singapore and to identify factors associated with depression. BACKGROUND: Unlike most internal illness, skin disease is often immediately visible to others and therefore people suffers from dermatological conditions may suffer psychological consequences. DESIGN: A descriptive survey was conducted during the period October 2009-August 2010 in Singapore; 145 vitiligo patients aged 21+ completed a structured questionnaire. METHODS: Three main outcome variables were employed in the study: demographic characteristics, clinical and psychosocial outcomes. RESULTS: Among the patients, 17·2% (n = 25) had been identified as depressed. Multiple logistic regression analyses were used to identify a model to predict vitiligo patients who will have depression. The results showed that females (p = 0·05), aged below 50 years old (p = 0·016), having 5+ years of illness (p = 0·021) and with low self-esteem (p = 0·002) and poor quality of life scores (p = 0·004) were significant risk factors for depression. CONCLUSION: Providing a suitable health care consultation for vitiligo patients may reduces depressive symptoms and maintaining their psychological health may be crucial for preventing suffering from depressive symptoms. Apart from the findings, these conclusions resonate with recent Singapore guidance on managing depression in vitiligo patients. This stresses the importance of prevention, early detection and stepped care with a multifaceted approach to management. RELEVANCE TO CLINICAL PRACTICE: It is important to regularly screen for depressive symptoms among vitiligo patients. Focusing on vitiligo patients with enhancing self-esteem and improving quality of life should help in both the prevention and recognition of onset of depression among vitiligo patients.

Exploring the psychological health related profile of nursing students in Singapore: a cluster analysis.

AIM: To determine whether definable profiles exist in a cohort of nursing student with regard to factors associated with nurses' perceived emotional intelligence, social support and stress level. BACKGROUND: There is a need to have a basic understanding of a nursing student's psychological health-related life quality profile will have a direct effect on their study and contribution to nursing educators to develop an appropriate learning environment for nursing students. DESIGN: A descriptive survey. METHODS: Data were collected in January 2009 in one nursing school in Singapore. A sample of 112 full-time baccalaureate nursing students from year 1-3 completed the stress in nursing students, social support rating scale and Trait meta-mood scale. RESULTS: Cluster analysis revealed two profiles in four main factors: demographic, perceived emotional intelligence, social support and stress level. CONCLUSIONS: Findings might help by providing important information for health care professionals to develop interventions that improve students' psychological health during their university life. RELEVANCE TO CLINICAL PRACTICE: The findings will assist nursing educators or health care professionals by creating psychological health-related life quality profiles that they can use to develop interventions to improve the health of nursing students.